Clinical outcomes and graft characteristics in pediatric matched sibling donor transplants using granulocyte colony-stimulating factor-primed bone marrow and steady-state bone marrow.
Matched sibling donor (MSD) transplant is a life-saving procedure for children with various hematological malignancies and non-malignancies. Traditionally, steady-state bone marrow (S-BM) has been used as the source of stem cells. More recently, peripheral blood stem cell (PBSC) after granulocyte-colony stimulating factor (G-CSF) mobilization has gained popularity. Adult studies of G-CSF-primed BM (G-BM) have shown that it produces rapid white blood cell engraftment like PBSC, but with less chronic graft-vs.-host disease. No such study has been published in pediatric patients. We conducted a pilot clinical trial of G-BM for pediatric patients. Ten patients were enrolled and were compared to a contemporaneous group of 12 patients who received S-BM. Patients in the G-BM group received a higher dose of total nucleated cells/kg (7.01 vs. 3.76 x 10(8), p = 0.0009), higher granulocyte-macrophage colony-forming units (CFU-GM)/kg (7.19 vs. 3.53 x 10(5), p = 0.01) and had shorter inpatient length of stay (28 vs. 40 days, p = 0.04). The engraftment, transfusion requirement and disease-free survival between the two groups were similar. We concluded that G-BM should be considered as an alternative graft source to S-BM, with the benefits of larger graft cell dose, higher CFU-GM dose and shorter length of stay.
Chiang
Kuang-Yueh
KY
Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Atlanta, GA, USA. kuang-yueh.chiang@choa.org
Haight
Ann
A
Horan
John
J
Olson
Ellen
E
Gartner
Amy
A
Hartman
Deborah
D
Youssef
Susanne
S
Worthington-White
Diana
D
D000293:Adolescent; D001853:Bone Marrow / Q000187:drug effects; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D006402:Hematologic Diseases / Q000601:surgery; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D010865:Pilot Projects; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D016179:Granulocyte Colony-Stimulating Factor