CD34+-enriched-CD19+-depleted autologous peripheral blood stem cell transplantation for chronic lymphoproliferative disorders: high purging efficiency but increased risk of severe infections.
OBJECTIVE
The main objective of this work was to decrease the incidence of relapse after autologous stem cell transplantation with a "double purging" procedure.


METHODS
We used a "positive" (CD34) and "negative" (CD19) double selection method to improve the efficacy of "single purging" of hematopoietic harvests in poor-prognosis lymphoproliferative disorders. All patients included in the study had a positive molecular marker of their disease. Minimal residual disease (MRD) was studied by flow cytometry and PCR techniques during the purging procedure and after transplantation.


RESULTS
Twenty-six patients fulfilled entry criteria. Median age of patients was 50 years (range: 33-66); 17 were male and 9 female. Thirteen (50%) of the patients mobilized an adequate number of CD34+ cells (>or=3 x 10(6)/kg) to proceed with the double-selection protocol. Twelve of the 13 harvests became PCR negative after purging. Ten patients were grafted with the selected products and all but one engrafted without delay. After a median follow-up of 30 months, 2 of 10 patients suffered a molecular relapse at 7 and 19 months respectively. The earlier relapse was observed in the patient who received a MRD+ product. Only one patient experienced a clinical relapse. Three patients died due to obliterans bronchiolitis, pneumococcal sepsis, and septic shock of unknown origin, respectively, and three others presented life-threatening infections.


CONCLUSIONS
Therefore, CD34+/CD19+ positive/negative selection is an effective purging approach in patients with chronic lymphoproliferative disorders. This favorable effect is, however, counterbalanced by the high frequency of life-threatening infections.
Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain. aaltesh@hsp.santpau.es
Albert
A
Altès
Jorge
J
Sierra
Jordi
J
Esteve
Gregorio
G
Martín-Henao
Pedro
P
Marín
Anna
A
Sureda
Javier
J
Briones
Rodrigo
R
Martino
Neus
N
Villamor
Dolors
D
Colomer
Enric
E
Carreras
J
J
Garcia
Salut
S
Brunet
Emili
E
Montserrat
D000328:Adult; D000368:Aged; D018941:Antigens, CD19 / Q000032:analysis*; D018952:Antigens, CD34 / Q000032:analysis*; D001424:Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D001773:Blood Cells / Q000737:chemistry / Q000637:transplantation*; D016465:Bone Marrow Purging / Q000379:methods*; D001989:Bronchiolitis Obliterans / Q000209:etiology; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000737:chemistry / Q000145:classification*; D006801:Humans; D016867:Immunocompromised Host; D018189:Immunomagnetic Separation; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008224:Lymphoma, Follicular / Q000150:complications / Q000473:pathology / Q000628:therapy*; D020522:Lymphoma, Mantle-Cell / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D018805:Sepsis / Q000209:etiology; D012772:Shock, Septic / Q000209:etiology; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D018941:Antigens, CD19; D018952:Antigens, CD34