title: CD34+ cell dose predicts survival, posttransplant morbidity, and rate of hematologic recovery after allogeneic marrow transplants for hematologic malignancies.
abstract: After autologous or allogeneic transplants of peripheral blood stem cells (PBSC), an adequate dose of CD34+ cells is necessary to ensure early and sustained hematopoietic engraftment and favorable clinical outcome. There are no comparable data on the relationship between CD34+ cell dose and recovery after allogeneic bone marrow transplants (BMT). Twenty-eight patients with hematologic malignancies received a BMT from an HLA-identical sibling, using T-cell depletion and cyclosporin for graft-versus-host disease prophylaxis and delayed donor lymphocyte transfusions in an attempt to prevent leukemia relapse. The treatment-related mortality (TRM), primarily due to infections and cytopenias, was significantly higher for 13 patients receiving less than 1 x 10(6) CD34+ cells/kg (64.9% +/- 12.8% v 6.9% +/- 6.4%, P = .003). Survival at a median follow-up of 1 year was also lower in the group receiving less than 1 x 10(6) CD34+ cells/kg (30.8% +/- 12.8 v 74.3% +/- 13.7%, P = .005). The CD34+ cell dose was the only variable significantly associated with TRM. The dose of CD34+ cells also correlated with speed of hematopoistic recovery. Patients receiving more than 2 x 10(6) CD34+ cells/kg showed significantly earlier recovery of monocytes and a trend for earlier recovery of lymphocytes. They achieved platelet and red blood cell transfusion independence earlier, required less granulocyte colony-stimulating factor support during ganciclovir treatment, and spent fewer days in the hospital after transplantation. These results suggest that, for allogeneic T-cell-depleted BMT, the higher CD34+ cell doses may improve outcome in engrafting patients.
authors.affiliation: Bone Marrow Transplant Unit, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
authors.forename: D
authors.initials: D
authors.lastname: Mavroudis
authors.forename: E
authors.initials: E
authors.lastname: Read
authors.forename: M
authors.initials: M
authors.lastname: Cottler-Fox
authors.forename: D
authors.initials: D
authors.lastname: Couriel
authors.forename: J
authors.initials: J
authors.lastname: Molldrem
authors.forename: C
authors.initials: C
authors.lastname: Carter
authors.forename: M
authors.initials: M
authors.lastname: Yu
authors.forename: C
authors.initials: C
authors.lastname: Dunbar
authors.forename: J
authors.initials: J
authors.lastname: Barrett
mesh_terms: D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D002452:Cell Count; D002648:Child; D015331:Cohort Studies; D005260:Female; D005434:Flow Cytometry; D006085:Graft Survival; D019337:Hematologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006412:Hematopoietic Stem Cells / Q000737:chemistry / Q000166:cytology; D006801:Humans; D015993:Life Tables; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34