Reduced risk of acute GVHD following mobilization of HLA-identical sibling donors with GM-CSF alone.
We retrospectively reviewed the results of transplanting peripheral blood progenitor cell (PBPC) allografts from HLA-matched sibling donors mobilized using various hematopoietic cytokines. Patients had received allografts mobilized with Granulocyte colony-stimulating factor (G-CSF) (G, N = 65) alone, G plus Granulocyte-macrophage colony stimulating factor (GM-CSF) (G/GM, N = 70), or GM-CSF alone at 10 or 15 microg/kg/day (GM, N = 10 at 10 microg/kg/day and 21 at 15 microg/kg/day). The CD34+ and CD3+ cell content of grafts were significantly lower following GM alone compared to G alone (P < 0.001 and 0.04, respectively). Nonhematopoietic toxicity observed in donors precluded dose escalation of GM-CSF beyond 10 microg/kg/day. Hematopoietic recovery was similar among all three groups. Grades II-IV acute graft-versus-host disease (GVHD) was observed in only 13% of patients in the GM alone group compared to 49 and 69% in the G alone or G/GM groups, respectively (P < 0.001). In a multivariate analysis, receipt of PBPC mobilized with GM alone was associated with a lower risk of grades II-IV acute GVHD (hazard ratio 0.21; 95% CI 0.073, 0.58) compared to G alone or G/GM. There were no differences in relapse risk or overall survival among the groups. Donor PBPC grafts mobilized with GM-CSF alone result in prompt hematopoietic engraftment despite lower CD34+ cell doses and may reduce the risk of grades II-IV acute GVHD following HLA-matched PBPC transplantation.
Devine
S M
SM
Siteman Cancer Center and Department of Medicine, Division of Oncology, Section of Stem Cell Transplantation, Leukemia, and Stem Cell Biology, Washington University School of Medicine, St Louis, MO, USA. sdevine@im.wustl.edu
Brown
R A
RA
Mathews
V
V
Trinkaus
K
K
Khoury
H
H
Adkins
D
D
Vij
R
R
Sempek
D
D
Graubert
T
T
Tomasson
M
M
Goodnough
L T
LT
DiPersio
J F
JF
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34; D017252:CD3 Complex; D002452:Cell Count; D004341:Drug Evaluation; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control*; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000633:toxicity; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage* / Q000633:toxicity; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects* / Q000379:methods; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012306:Risk; D035781:Siblings; D014184:Transplantation, Homologous
D018952:Antigens, CD34; D017252:CD3 Complex; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor