The number of infused CD34+ cells does not influence the incidence of GVHD or the outcome of allogeneic PBSC transplantation, using reduced-intensity conditioning and antithymocyte globulin

Abstract

The influence of graft composition on the outcome of reduced-intensity (RIC) allogeneic PBSC transplantation (allo-PBSC) remains controversial. In this study, we analyzed the impact of CD34 þ cell dose on the incidence of GVHD, and on the outcome after allo-PBSC, in 103 patients with hematological malignancies, using a uniform RIC regimen. The following variables were included in statistical analysis: (1) number of C34 þ cells, (2) highrisk vs low-risk disease status, (3) matched related vs matched unrelated donor, (4) female donor to male recipient vs any other combination, (5) age of recipient (above vs below the median). Univariate and multivariate analysis did not reveal any association between CD34 þ cell dose and acute grade-2 to grade-4, cGVHD, nonrelapse mortality (NRM), relapse rate (RR) and OS. High-risk disease status was the only variable independently associated with increased NRM (P ¼ 0.001), increased RR (P ¼ 0.012) and decreased OS (Po0.001). The same results were obtained when analysis was restricted to a subgroup of 55 patients with myeloid neoplasms. The influence of graft composition on the outcome of RIC allo-PBSC should be further investigated via well-controlled randomized prospective studies.

Effect of Total Nucleated and CD34+ Cell Dose on Outcome after Allogeneic Hematopoietic Stem Cell Transplantation

“…However, many studies have shown the risk for chronic graft-versus-host disease (GVHD) is increased in patients receiving PBSC compared with BM, probably because of the higher cell content [11][12][13]. More recently, only a few studies have evaluated the effect of cell dose on outcome after HSCT [4,[14][15][16]. Hence, it is important to establish which cell dose is optimal for outcome when using BM or PBSC in the modern era of HSCT.…”

Incidence and risk factors for moderate-to-severe veno-occlusive disease of the liver after allogeneic stem cell transplantation using a reduced intensity conditioning regimen

“…All the other patients were classified as high-risk patients. 6 Pre-existing liver disease was defined as the presence of liver infiltration by tumor, chronic viral infection or the presence of alcoholic liver disease.…”

Infused total nucleated cell dose is a better predictor of transplant outcomes than CD34 + cell number in reduced-intensity mobilized peripheral blood allogeneic hematopoietic cell transplantation

“…8 These examples typify the myriad of published analyses that have, thus far, failed to demonstrate reproducible, consensus data regarding the effect of CD34 + cell dose on common RIC transplant outcomes. [1][2][3][4][5][13][14][15][16][17][18] In contrast to CD34 + cell dose, there have been only a limited number of studies that report on the effect of TNC dose on RIC transplant outcomes. Baron and colleagues analyzed graft composition data from 125 RIC patients, showing a non-significant, but appreciable trend (HR=0.08, P=0.06) toward improved overall survival, as well as progression-free survival, with higher TNC dose.…”

“…These studies have primarily focused on CD34 + cell dose, most reporting that higher CD34 + cell doses are associated with more rapid engraftment with a variable effect on the incidence of graft-versus-host disease (GVHD) and survival outcomes. [1][2][3][4][5] Gomez-Almaguer and colleagues reported on 138 recipients of RIC hematopoietic stem cell transplants, showing that higher CD34 + doses correlated with improved overall survival. 6 A CIBMTR registry analysis of 1054 RIC hematopoietic stem cell transplant recipients found that lower CD34 + doses correlated with increased transplant-related mortality and decreased overall survival.…”