title: Donor, recipient, and transplant characteristics as risk factors after unrelated donor PBSC transplantation: beneficial effects of higher CD34+ cell dose.
abstract: We report outcomes of 932 recipients of unrelated donor peripheral blood stem cell hematopoietic cell transplantation (URD-PBSC HCT) for acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, and myelodysplastic syndrome enrolled on a prospective National Marrow Donor Program trial from 1999 through 2003. Preparative regimens included myeloablative (MA; N = 611), reduced-intensity (RI; N = 160), and nonmyeloablative (NMA; N = 161). For MA recipients, CD34(+) counts greater than 3.8 x 10(6)/kg improved neutrophil and platelet engraftment, whereas improved overall survival (OS) and reduced transplant-related mortality (TRM) were seen for all preparative regimens when CD34(+) cell doses exceeded 4.5 x 10(6)/kg. Higher infused doses of CD34(+) cell dose did not result in increased rates of either acute or chronic graft-versus-host disease (GVHD). Three-year OS and disease-free survival (DFS) of recipients of MA, RI, and NMA approaches were similar (33%, 35%, and 32% OS; 33%, 30%, and 29% DFS, respectively). In summary, recipients of URD-PBSC HCT receiving preparative regimens differing in intensity experienced similar survival. Higher CD34(+) cell doses resulted in more rapid engraftment, less TRM, and better 3-year OS (39% versus 25%, MA, P = .004; 38% versus 21% RI/NMA, P = .004) but did not increase the risk of GVHD. This trial was registered at www.clinicaltrials.gov as #NCT00785525.
authors.affiliation: University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT 84132-2408, USA. michael.pulsipher@hsc.utah.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.forename: Pintip
authors.initials: P
authors.lastname: Chitphakdithai
authors.forename: Brent R
authors.initials: BR
authors.lastname: Logan
authors.forename: Susan F
authors.initials: SF
authors.lastname: Leitman
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: John P
authors.initials: JP
authors.lastname: Miller
authors.forename: Roberta J
authors.initials: RJ
authors.lastname: King
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Confer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018952:Antigens, CD34 / Q000378:metabolism*; D001772:Blood Cell Count; D001773:Blood Cells / Q000378:metabolism* / Q000473:pathology / Q000637:transplantation; D001782:Blood Donors; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007938:Leukemia / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous
chemical_list: D018952:Antigens, CD34