Early lymphocyte recovery is an important determinant of outcome following allogeneic transplantation with CD34+ selected graft and limited T-cell addback.
We evaluated the outcome of 29 patients (age 22-60 years), who received a CD34+selected related (n=16) or unrelated graft (n=13) with limited T-cell addback (TCAB) (median 5.9 x 10(4)/kg) following full-intensity conditioning for haematological malignancies. In all, 16 patients (55%) had either advanced disease or previous transplants. The cumulative incidences of grade 2-4 acute GVHD were 15.4 and 19.2% and that for chronic extensive GVHD were 35 and 37% in related and unrelated graft recipients, respectively. The strongest predictor of nonrelapse mortality and overall survival was the absolute lymphocyte count (ALC) at 30 days; patients with ALC<0.35 x 10(9)/l having an NRM and OS of 59.2 and 24.7%, compared to 10 and 90% in those with a higher ALC. Patients with acute leukaemia had poorer survival and this was associated with a lower ALC as well. Thus, TCAB with a CD34+ selected graft resulted in a comparable outcome in both older and younger patients, but the survival was strongly influenced by early lymphocyte recovery.
Chakrabarti
S
S
Adult Bone Marrow Transplant Unit, Bristol Royal Hospital for Sick Children, Bristol, UK.
Brown
J
J
Guttridge
M
M
Pamphilon
D H
DH
Lankester
A
A
Marks
D I
DI
D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis*; D017252:CD3 Complex / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology / Q000473:pathology; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D006801:Humans; D017710:Lymphocyte Transfusion / Q000379:methods*; D038041:Lymphopoiesis; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology / Q000382:microbiology; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010865:Pilot Projects; D011336:Probability; D012008:Recurrence; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D018952:Antigens, CD34; D017252:CD3 Complex