Allogeneic transplantation of CD34+-selected cells from peripheral blood in patients with myeloid malignancies in early phase: a case control comparison with unmodified peripheral blood transplantation.
An allogeneic transplantation of CD34(+)-selected cells from peripheral blood (allo-PBT/CD34(+)) from HLA-identical sibling donors was performed in 50 adult patients with acute myeloid leukemia in first complete remission (AML CR1) (n = 29), myelodysplastic syndrome (MDS) (n = 4), or chronic myeloid leukemia in first chronic phase (CML CP1) (n = 17). Clinical results were compared to a concurrent group of 50 patients transplanted with unmodified peripheral blood progenitor cells (allo-PBT), matched for age, diagnosis, and disease stage. The median follow-up period was 29 months (range 1-69). The actuarial probability of developing acute GVHD clinical grade II to IV was 16% (95%CI: 6-26) for the allo-PBT/CD34(+) group and 41% (95%CI: 29-57) for the allo-PBT group (P = 0.002). The actuarial probability of developing extensive chronic GVHD was 22% (95%CI: 8-36) for the allo-PBT/CD34(+) group and 47% (95%CI: 31-63) for the allo-PBT group (P = 0.02). Recipients of allo-PBT/CD34(+) had less toxicity associated with the transplant and better Karnofsky index at the last follow-up. For AML/MDS patients, the actuarial probability of disease-free survival (DFS) for recipients of allo-PBT/CD34(+) and allo-PBT was 65% (95%CI: 45-85) vs43% (95%CI: 28-58) (P = 0.05), respectively. These data provide a rationale for a randomised trial of allo-PBT/CD34(+) vs allo-PBT in AML/MDS patients in early stage of the disease.
Urbano-Ispizua
A
A
Depatment of Hematology, Hospital Clinic, University of Barcelona, Spain.
Brunet
S
S
Solano
C
C
Moraleda
J M
JM
Rovira
M
M
Zuazu
J
J
de La Rubia
J
J
Bargay
J
J
Caballero
D
D
Díez-Martín
J L
JL
Ojeda
E
E
Pérez de Oteiza
J P
JP
Ferrá
C
C
Espigado
I
I
Alegre
A
A
de La Serna
J
J
Torres
P
P
Riu
C
C
Odriozola
J
J
Rozman
C
C
Sierra
J
J
García-Conde
J
J
Montserrat
E
E
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000754:Anemia, Refractory, with Excess of Blasts / Q000401:mortality / Q000628:therapy*; D018952:Antigens, CD34 / Q000096:biosynthesis* / Q000097:blood; D001803:Blood Transfusion / Q000401:mortality; D016022:Case-Control Studies; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014184:Transplantation, Homologous
D018952:Antigens, CD34