Allogeneic transplantation of G-CSF mobilized peripheral blood stem cells from unrelated donors: a retrospective analysis.
OBJECTIVE
Allogeneic peripheral blood stem cell transplantation (PBSCT) from matched siblings has lead to clinical results comparable to those of standard bone marrow transplantation (BMT). We report the outcome of 79 patients transplanted with PBSC from unrelated donors.


METHODS
In 61 cases PBSC were used for primary transplantation whereas 18 patients were treated for relapse or graft-failure. In 35 patients receiving primary transplants, T-cell depletion (TCD) using CD34 positive selection of PBSC with or without additional T-cell depletion had been performed to reduce the risk of graft-versus-host-disease (GvHD).


RESULTS
The rate of primary graft-failure was higher (20%) in the TCD group than in that receiving unmanipulated grafts (UM) (5%, p=0.007). Patients with standard risk (n=34) receiving first transplants had a significantly better overall (60.4% vs. 24%, p=0.02) and disease-free survival (57.2% vs. 22.3%, p=0.006) compared to a high risk group of patients (n=21). There were no differences in the speed of neutrophil and platelet engraftment between TCD and UM transplants. As expected, the cumulative risk for acute GvHD grade II.-IV was significantly higher in the patients who had received UM grafts (71.8% vs. 38.1%, p=0.005). Although a trend towards a better survival rate was observed after TCD transplantation (52.2%) compared to the UM group (38.1%), this difference was not statistically significant. The probability of relapse was significantly higher in patients after UM transplants (38.8% vs. 8. 4%). This apparent paradox is explained by the higher number of high-risk patients in this group (p=0.03). Multivariable analysis of disease-free survival revealed risk category (p=0.02) and use of ATG (p=0.03) to be of significant impact. All patients (n=6) with non-malignant diseases are alive with full donor chimerism.


CONCLUSIONS
These data show that PBSC from unrelated donors can be transplanted either unmanipulated or CD34 selected. Prospective studies comparing BMT with PBSCT from unrelated donors are needed in defined disease categories.
Bornhäuser
M
M
Med. Klinik I, Universit tsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany. bornhaeuser@oncocenter.de
Theuser
C
C
Soucek
S
S
Hölig
K
K
Klingebiel
T
T
Blau
W
W
Fauser
A
A
Runde
V
V
Schwinger
W
W
Rutt
C
C
Ehninger
G
G
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D030342:Genetic Diseases, Inborn / Q000401:mortality / Q000628:therapy; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D006402:Hematologic Diseases / Q000401:mortality / Q000628:therapy; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D007239:Infections / Q000209:etiology / Q000401:mortality; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome
D016179:Granulocyte Colony-Stimulating Factor