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Higher doses of CD34+ progenitors are associated with improved overall survival without increasing GVHD in reduced intensity conditioning allogeneic transplant recipients with clinically advanced disease
Author(s) -
GómezAlmaguer David,
GómezPeña Álvaro,
JaimePérez José Carlos,
GómezGuijosa Miguel Ángel,
CantúRodríguez Olga,
GutiérrezAguirre Homero,
MartínezCabriales Sylvia Aidé,
GarcíaRodríguez Fernando,
OlguínRamírez Leticia A.,
SalazarRiojas Rosario,
MéndezRamírez Nereida
Publication year - 2013
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21278
Subject(s) - medicine , cd34 , apheresis , gastroenterology , transplantation , incidence (geometry) , granulocyte colony stimulating factor , progenitor cell , graft versus host disease , immunology , urology , stem cell , surgery , chemotherapy , platelet , genetics , physics , optics , biology
Objective The influence of CD34+ cell dose on the outcome of allogeneic peripheral blood stem cell (PBSC) transplantation after reduced intensity conditioning (RIC) remains controversial. The impact of the number of CD34+ hematoprogenitors infused on transplant outcome and on the incidence of graft versus host disease (GVHD) was analyzed. Materials and methods Data of 138 patients with advanced hematological diseases who received an allogeneic PBSC transplant after RIC were analyzed. Donors were mobilized with granulocyte colony‐stimulating factor and underwent one to three apheresis procedures. Incidence of acute and chronic GVHD and overall and event‐free survival (OS and EFS) was determined. Results The median number of CD34+ cells infused was 5.57 × 10 6 kg −1 (range: 1.1–15.6). There was no relationship between CD34+ cell dose and neutrophil or platelet engraftment. Patients receiving ≥5 × 10 6 kg −1 CD34+ cells had a 63.1% 5‐year OS when compared with 48.2% for those receiving a lower number ( P = 0.024). At 5‐year follow‐up, there was no significant difference in EFS between the groups (44% vs. 42.8%, P = 0.426). No relationship between CD34+ cell dose and acute GVHD was found ( P = 0.1). Relapse rate was the same in patients with and without acute GVHD ( P = 0.117). A nonsignificant improvement on OS and EFS in patients who developed chronic GVHD was found ( P = 0.57 and 0.41). Conclusion A CD34+ cell dose ≥5 × 10 6 kg −1 was associated with a significantly higher OS, but no improved EFS in high‐risk patients. The number of CD34+ progenitors infused had no influence on the incidence of acute or chronic GVHD. J. Clin. Apheresis 28:349–355, 2013. © 2013 Wiley Periodicals, Inc.