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- Title
Poor graft function can be durably and safely improved by CD34-selected stem cell boosts after allogeneic unrelated matched or mismatched hematopoietic cell transplantation.
- Authors
Haen, Sebastian; Schumm, Michael; Faul, Christoph; Kanz, Lothar; Bethge, Wolfgang; Vogel, Wichard
- Abstract
Purpose: Insufficient production of leukocytes, thrombocytes and erythrocytes after allogeneic peripheral blood stem cell transplantation (PBSCT) represents a life-threatening complication. Methods: In 20 adult patients with poor graft function (PGF defined as transfusion-dependent platelet counts <20,000/µl, or leukocytes <1500/µl, or transfusion-dependent anemia) and variable causes of PGF after allogeneic PBSCT, immunomagnetically selected CD34 stem cell boosts (SCB) from matched unrelated ( n = 8), mismatched unrelated ( n = 11) or haploidentical ( n = 1) donors were applied without prior conditioning. Results: Patients received a median of 4.6 × 10 CD34 cells per kilogram bodyweight (1.9-9.1 × 10) and low T cell numbers (median 0.2 × 10, range 0.04-0.6 × 10). All patients showed responses in at least one hematopoietic lineage. Engraftment for platelets, leukocytes and hemoglobin was 88, 88 and 100 % after a median of 14, 13 and 18 days, respectively. With regard to the complete cohort, 90 % ( n = 18) showed an increase in platelets (median 76,500/µl, range −7000 to 223,000/µl), 95 % ( n = 19) had an increase in leukocytes (median 3110/µl, range 150-13,740/µl) and 90 % ( n = 18) improved with regard to hemoglobin (median 1.9 g/dl, range −0.9 to 5.1 g/dl). Due to effective T cell depletion, only one patient developed graft versus host disease (GvHD, grade III) after SCB. Patients were followed for a median of 7.5 months (1-74 months) with 11 patients being alive and disease free with normalized peripheral blood counts at the end of follow-up. Conclusions: CD34-selected SCB are safe and effective and can durably improve PGF even in patients receiving grafts from unrelated matched or mismatched donors with low incidence of GvHD.
- Subjects
HEMATOPOIETIC stem cell transplantation; HOMOGRAFTS; CD34 antigen; LEUCOCYTES; BLOOD platelets; ERYTHROCYTES; SURGICAL complications
- Publication
Journal of Cancer Research & Clinical Oncology, 2015, Vol 141, Issue 12, p2241
- ISSN
0171-5216
- Publication type
Article
- DOI
10.1007/s00432-015-2027-x