Feasibility and safety of peripheral blood stem cell transplantation from unrelated donors: results of a single-center study

Abstract

Summary:We compared the outcomes in patients receiving unrelated peripheral blood stem cell transplants (PBSCT) with those receiving bone marrow transplants (BMT) in a matched pair analysis. Seventy-four patients with hematological malignancies with HLA-matched (77%) and mismatched (23%) donors were analyzed in this study. Thirty-four patients (45%) were considered as high risk patients. Sixty-eight patients received standard conditioning regimens with Bu/Cy or TBI/Cy. Six patients received an intensified conditioning regimen with the addition of etoposide, thiotepa or melphalan. GVHD prophylaxis consisted of prednisolone, cyclosporine and methotrexate. Groups were matched for patient, donor, transplant characteristics and HLA compatibility. Peripheral blood stem cell collection led to the collection of a higher number of CD34 + and CD3 + cells in comparison to bone marrow collection. Leukocyte engraftment in the PBSCT group occurred in 14 days (median; range 6-26 days) and in the BMT group in 19 days (range 9-29 days; P Ͻ 0.02). The time of platelet engraftment did not differ significantly. The incidence of grades II-lV acute GVHD in the group of HLA-identical patients was 35% in the PBSCT group and 25% in the BMT group (P Ͻ 0.33, log-rank). However, there was a significant difference (P Ͻ 0.05, logrank) in incidence and time to onset of acute GVHD II-IV comparing all patients, including the 17 mismatched transplants. Disease-free survival was 51% (19 patients) with a median of 352 days and 59% (21 patients) with a median of 760 days for PBSC and BMT transplants, respectively. In conclusion, our results indicate that allogeneic PBSCT led to significantly faster leukocyte engraftment but is associated with a higher incidence and more rapid onset of severe acute GVHD comparing all patients, including the 17 mismatched transplants. However, the incidence of severe acute GVHD in HLAidentical patients was not different between the PBSCT and BMT groups. Bone Marrow Transplantation (2001) 27, 27-33.

Patients with acute lymphoblastic leukaemia allografted with a matched unrelated donor may have a lower survival with a peripheral blood stem cell graft compared to bone marrow

“…With unrelated donors, the Idar-Oberstein group, on a total of 74 patients, found a similar incidence of severe aGVHD with PBSC and BM from HLA-matched unrelated donors but a higher one with PBSC in cases of HLA mismatch. 11,12 Currently, in fact, there is limited information on which source to select when undertaking family mismatched and unrelated transplants. Therefore, the present study from the EBMT registry addressed the question precisely in patients transplanted using unrelated donors.…”

“…[9][10][11][12] Furthermore, there is presently no guideline regarding the preferred source of stem cells (PBSC or BM) from unrelated volunteer donors, and for each procedure the source is usually selected by the centre of harvest rather than the centre that actually does the transplant. 13,14 The major risk when selecting PBSC over marrow concerns the higher number of T cells infused and the increased risk of acute and/or chronic GVHD.…”

Transplantation of highly purified peripheral-blood CD34+ progenitor cells from related and unrelated donors in children with nonmalignant diseases

“…15 One way to prevent graft failure despite extensive T-cell depletion, especially in the case of HLA-mismatched transplantation, is to transplant large numbers of CD34 þ stem cells, 16 which can be harvested from donor peripheral blood after mobilization with G-CSF. 17 This megadose concept has been used successfully in MUD and three-loci haploidentical donor transplantation in pediatric 18,19 and adult 20 patients with malignant diseases.…”

No difference in graft-versus-host disease, relapse, and survival comparing peripheral stem cells to bone marrow using unrelated donors

“…21 Detailed descriptions of the myeloablative therapy, immunosuppression, and patient care at the different centers have been reported elsewhere. 10,22,23 As additional immunosuppressive treatment before transplant, one third of the patients (mainly at Huddinge) were given antithymocyte globulin (ATG-Fresenius, Fresenius AG, Bad Homburg, Germany, or Thymoglobulin, IMTIX-Sangstat, Lyon, France) or monoclonal anti-T-cell antibodies (Orthoclone OKT3, Ortho Biotech, Raritan, NJ) for 4 to 5 days. 24 …”

“…8 Until recent years most reports concerned PBSC grafts using HLA-A, -B, and -DR-identical sibling donors; data have been reported on only a few patients who received PBSC from unrelated donors. [10][11][12][13][14] There have been several reasons for the reluctance to use PBSCs from unrelated donors. One concern has been the ethics of administering granulocyte colony-stimulating factor (G-CSF) to mobilize PBSCs from healthy volunteers.…”