title: Effect of CD34 cell dose on hematopoietic reconstitution and outcome in 508 patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation.
abstract: BACKGROUND
  We analyzed the hematopoietic reconstitution and outcome of 508 patients with multiple myeloma (MM) with respect to the number of CD34+ cells reinfused at our center.
  
  
  METHODS
  Each cohort of 390 patients (unselected CD34+ cell transplant) and 118 patients (CD34+ selected transplant) was divided into four subgroups. Among the 390 transplantations, 86 patients received a high dose (HD-) of > or =6.50 x 10(6) unselected CD34+ cells/kg, 116 patients a low dose (LD-) of <3.00 x 10(6) CD34+ cells/kg. Among the patients treated with CD34+ selected PBSC, 34 received > or =6.50 x 10(6) CD34+ cells/kg (HD+) and 16 <3.00 x 10(6) CD34+ cells/kg (LD+).
  
  
  RESULTS
  HD- patients experienced a reduced median time to leukocyte (13 d vs. 14 d) (P < 0.001) and platelet reconstitution >20 x 10(9)/L (10 d vs. 12 d) (P < 0.001). Similarly, HD+ showed a reduced median time to leukocyte (12 d vs. 15 d) (P < 0.001) and platelet recovery >20 x 10(9)/L (10 d vs. 11 d) (P = 0.058). CD34+ cell-dose was significant for long-term platelet recovery at day 360 (unselected transplant P = 0.015, selected transplant P = 0.023). Number of transplanted CD34+ cells had no significant impact on transplant related mortality, overall survival or CR/PR rates within 100 d. In terms of supportive care the differences of high-/low-dose grafts were minimal.
  
  
  CONCLUSIONS
  These results confirm that high doses of CD34+ PBSC shorten hematopoietic reconstitution and reduce hospitalization. Nevertheless secure engraftment results from transplantation of 2.00-3.00 x 10(6) CD34+ cells/kg. As 60% of our pretreated patients are able to collect > or =5.00 x 10(6) CD34+ cells/kg within a single leukapheresis, division into two or more freezing bags allows safe tandem transplantation in the majority of MM patients.
authors.affiliation: Department of Internal Medicine V, University Heidelberg, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Klaus
authors.forename: Doris
authors.initials: D
authors.lastname: Herrmann
authors.forename: Iris
authors.initials: I
authors.lastname: Breitkreutz
authors.forename: Ute
authors.initials: U
authors.lastname: Hegenbart
authors.forename: Uta
authors.initials: U
authors.lastname: Mazitschek
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Egerer
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Cremer
authors.forename: Ray M
authors.initials: RM
authors.lastname: Lowenthal
authors.forename: Johannes
authors.initials: J
authors.lastname: Huesing
authors.forename: Stefan
authors.initials: S
authors.lastname: Fruehauf
authors.forename: Thomas
authors.initials: T
authors.lastname: Moehler
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000096:biosynthesis*; D015331:Cohort Studies; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006085:Graft Survival; D006410:Hematopoiesis; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D010976:Platelet Count; D011379:Prognosis; D015996:Survival Rate; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34