Matched-pair analysis of peripheral blood stem cells compared to marrow for allogeneic transplantation.
We performed a case-control analysis of 42 patients with advanced leukemia or MDS comparing peripheral blood stem cell (PBSC) with marrow grafts (BMT) from HLA-matched sibling donors. PBSC were mobilized with G-CSF (7.5 microg/kg/day) and yielded a median of 6.7 x 10(6) CD34+ cells/kg (range, 1.6-15.0) and 2.7 x 10(8) CD3+ cells/kg (range, 1.1-7.1) vs marrow grafts with a median of 2.0 x 10(8) nucleated cells/kg (range, 1.8-2.2). Recovery was significantly faster after PBSCT compared to BMT, with a median of 17 (range, 12-26) vs 26 (range, 16-36) days, respectively, to neutrophils >0.5 x 10(9)/l (P < 0.01), and 22 (range, 12->60) vs 42 (range, 18->60) days, for platelet recovery (P < 0.01). Transplantation of >/=7 x 10(6) CD34+ cells/kg accelerated recovery to >20 x 10(9) l platelets; median 17 days (range, 12-19) vs 23 days (range, 17-36) for those receiving <7 x 10(6)/kg (P = 0.01). PBSC and marrow recipients had similar risks of grades II-IV or III-IV acute GVHD or extensive chronic GVHD (all P > 0.3). At 1 year after PBSCT and BMT, the risk of relapse was 41% and 32%, respectively (P = 0.47), and the probability of survival was 46% and 48%, respectively (P = 0.70). HLA-matched sibling PBSCT resulted in faster neutrophil and platelet engraftment compared to BMT, with no subsequent differences in acute or chronic GVHD, relapse or survival. A minimum of 7 x 10(6) CD34+ cells/kg in PBSC grafts may be required for very rapid platelet engraftment. Bone Marrow Transplantation (2000) 26, 723-728.
Lickliter
J D
JD
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota, USA.
McGlave
P B
PB
DeFor
T E
TE
Miller
J S
JS
Ramsay
N K
NK
Verfaillie
C M
CM
Burns
L J
LJ
Wagner
J E
JE
Eastlund
T
T
Dusenbery
K
K
Weisdorf
D J
DJ
D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis; D001781:Blood Component Removal; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000592:standards*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000592:standards*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy; D009679:Nuclear Family; D012008:Recurrence; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods / Q000592:standards; D016896:Treatment Outcome
D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor