Comparison of marrow and blood cell yields from the same donors in a double-blind, randomized study of allogeneic marrow vs blood stem cell transplantation

Abstract

Summary:Forty healthy adult donors underwent marrow (BM) as well as peripheral blood (PBSC) stem cell collections for their HLA-identical adult siblings with hematologic malignancies. BM was harvested on day 1 (target 3 ؋ 10 8 nucleated cells/kg, 10 g/kg lenograstim (glycosylated G-CSF) administered on days 2-6, and a single leukapheresis performed on day 6. The blood volume processed was the higher of 200% donor blood volume or 10 liters. The total nucleated cell (TNC) yields from PBSC were 1.1-to 4.3-fold higher than BM (median 7.0 vs 3.1 ؋ 10 8 /kg, P Ͻ 0.0001). Although BM contained a higher proportion of CD34 + cells (1.3% vs 0.7%, P Ͻ 0.0001) and a comparable proportion of CD3 + cells (median 29% vs 26%, P = 0.4), the absolute numbers of CD34 + and CD3 + cells and their subsets were several times higher in PBSC. There was a poor correlation between BM and PBSC CD34 and TNC numbers, but a significant correlation between BM and PBSC CD3 numbers. Only five of 40 BM harvests contained у2 ؋ 10 6 CD34 + cells/kg compared with 35 of 40 PBSC harvests (P Ͻ 0.0001). We conclude that the numbers of progenitor and immunocompetent cells in PBSC are several times higher than in BM. It is possible to collect adequate numbers of progenitor cells from blood after lenograstim stimulation more frequently than from marrow, and donors yielding low quantities of progenitor cells from BM usually deliver better quantities from PBSC. Bone Marrow Transplantation (2000) 25, 501-505.

Matched-pair analysis comparing allogeneic PBPCT and BMT from HLA-identical relatives in childhood acute lymphoblastic leukemia

“…However, over the last few years mobilized peripheral blood has been used as an alternative source of stem cells for allogeneic transplantation. In adult patients, several retrospective and prospective randomized studies comparing allogeneic blood and bone marrow transplantation have indicated that allo-PBPCT is better than BMT in terms of engraftment kinetics and immune recovery with a similar incidence of acute GVHD, [7][8][9][10][11][12]24 although, issues regarding chronic GVHD incidence are still unresolved. In addition, two recent randomized studies have suggested a potential benefit for allo-PBPCT with respect to relapse and survival without an increased incidence of cGVHD.…”

“…This finding is in agreement with the results of other studies of allo-PBPCT in either adults or children. [7][8][9][10][11][12][24][25][26][27] A possible explanation for this may be the larger numbers of committed progenitors in cytokine-mobilized peripheral blood. As with another matched-pair analysis recently published, 27 we found no relationship between the CD34 ϩ cell dose and neutrophil engraftment.…”

A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: should 2 × 106 CD34+ cells/kg be considered the minimum threshold?

“…We have performed a randomized, double-blind study comparing allogeneic BMT and PBSCT in hematologic malignancies. 20 With the availability of prospectively collected data of the various cell subpopulations constituting the graft, 21 we attempted to examine the relationship between the number of CD34 ϩ cells infused and TRM.…”

The whys and hows of hematopoietic progenitor and stem cell mobilization

“…Patients transplanted with blood stem cells had better outcomes as regards disease-free survival and overall survival. 51 Whether the improvement was related to the larger number of stem/progenitor cells in a blood stem cell vs a marrow stem cell graft product 52 was neither discounted nor demonstrated. A second smaller randomized study of allogeneic marrow vs mobilized blood stem cell transplantation found that patients who received fewer than 2 Â 10 6 /kg CD34+ cells, regardless of the cell source, experienced higher mortality and poorer survival.…”