Allogeneic hematopoietic transplantation of CD34+ selected cells from an HLA haplo-identical related donor. A long-term follow-up of 135 patients and a comparison of stem cell source between the bone marrow and the peripheral blood.
We studied the outcome of allogeneic transplants in 135 patients who received selected BM and/or PBSC CD34+ cells from HLA haplo-identical related donors. Donor engraftment was achieved in 108 of 128 evaluable transplants. Engraftment failure occurred more often in non-malignant than in malignant diseases (10 of 25 vs 17 of 103, P = 0.010). The CD34+ cell dose was associated with the speed of neutrophil and platelet recovery, but the cell source was not. Acute GVHD (> or = grade II) developed in 21.0 +/- 3.7%. Chronic GVHD occurred more frequently in malignancies than in non-malignancies (44.1 +/- 7.6% vs 0.0%, P = 0.0075), and more in PBSC recipients than in BM recipients (53.6 +/- 9.4% vs 17.4 +/- 9.3%, P = 0.0054). Relapse rate was higher in high risk patients than in standard risk patients (78.7 +/- 7.1% vs 22.1 +/- 10.0%, P = 0.0001). Probabilities of disease-free survival (DFS) were 14.2 +/- 3.5% in malignancies and 25.7 +/- 9.2% in non-malignancies. Probabilities of DFS in standard and high risk patients were 39.4 +/- 9.2% and 5.7 +/- 2.8% (P = 0.0001). A high incidence of graft failure, infection and relapse was observed and resulted in high mortality.
Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan.
S
S
Kato
H
H
Yabe
M
M
Yasui
K
K
Kawa
T
T
Yoshida
A
A
Watanabe
Y
Y
Osugi
K
K
Horibe
Y
Y
Kodera
D000206:Actuarial Analysis; D000208:Acute Disease; D018952:Antigens, CD34 / Q000097:blood*; D001773:Blood Cells / Q000276:immunology / Q000637:transplantation; D001782:Blood Donors; D001854:Bone Marrow Cells / Q000276:immunology; D016026:Bone Marrow Transplantation; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D006239:Haplotypes / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality / Q000592:standards; D006650:Histocompatibility Testing; D006801:Humans; D014184:Transplantation, Homologous / Q000379:methods* / Q000401:mortality / Q000592:standards; D016896:Treatment Outcome
D018952:Antigens, CD34