Selected CD34 blood cell allografts for older patients: low transplant-related mortality, graft failure and acute GvHD.
BACKGROUND
Early transplant mortality is related to acute GvHD, which this study in older patients (40 to 60 years) decreased by reducing the graft T-cell number while maintaining a high CD34 cell number--by positive CD34 cell selection. Potential increased risk of relapse is addressed by giving donor leucocyte infusion (DLI) post-transplant.


METHODS
CD34 cells selected by Isolex devices from leukophereses obtained from Filgrastim-treated matched sibling donors were transplanted and DLI given later if there was no GvHD.


RESULTS
Selection of CD34 cells achieved a median of 5.2 million cells/kg, with minimum target for transplantation achieved in 17 of 21 donors. Median CD3 cell number was 0.24 million/kg. Engraftment was rapid and graft failure rare. Transplant-related mortality was low (6% at 3 months). Acute GvHD of >or=Grade 2 occurred in only two patients (12.5%). DLI were given to only six patients who had resolved Grade 1 or no GvHD. Eight of the 17 patients relapsed, including three of the six who had DLI. Extensive chronic GvHD developed in six of 12 evaluable patients, two of these had received DLI. Seven of the 17 patients (41%) are alive at median follow-up of 56 months.


CONCLUSIONS
CD34 selection allows transplantation of high numbers of CD34 cells with low CD3 cell count, reducing early mortality in patients 40-60 years old because of rapid hemopoietic reconstitution and low acute GvHD incidence. Administration of DLI was often precluded by low-grade acute GvHD.
Roberts
M M
MM
Division of Haematology, Hanson Centre for Cancer Research, Adelaide, South Australia.
Dyson
P
P
Rawling
C
C
Thorp
D
D
Rawling
T
T
White
D
D
Horvath
N
N
Bardy
P
P
Hui
C H
CH
Dart
G W
GW
To
L B
LB
Hughes
T P
TP
D000208:Acute Disease; D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis* / Q000276:immunology; D001773:Blood Cells / Q000166:cytology; D017252:CD3 Complex / Q000276:immunology; D002452:Cell Count; D002469:Cell Separation; D005260:Female; D000069585:Filgrastim; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control*; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D006680:HLA Antigens / Q000276:immunology; D019337:Hematologic Neoplasms / Q000628:therapy; D006801:Humans; D007937:Leukapheresis; D017708:Leukocyte Transfusion; D007962:Leukocytes / Q000276:immunology; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality; D010976:Platelet Count; D011994:Recombinant Proteins; D012008:Recurrence; D016019:Survival Analysis; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D018952:Antigens, CD34; D017252:CD3 Complex; D006680:HLA Antigens; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim