The effect of the composition of unrelated donor bone marrow and peripheral blood progenitor cell grafts on transplantation outcomes.
To test the hypothesis that the outcome of hematopoietic stem cell (HSC) grafts is at least partially determined by the cellular composition of the graft, the National Marrow Donor Program (NMDP) analyzed the correlation of cellular phenotypes of unrelated grafts with graft outcome. Samples from 94 bone marrow (BM) and 181 peripheral blood progenitor cell (PBPC) grafts for transplantations at 40 U.S. transplant centers between 2003 and 2005 were analyzed at a single immunophenotyping reference laboratory. Samples were shipped from transplant centers upon receipt of graft. Graft cellular composition included analysis of leukocyte total cell numbers, and subsets of myeloid [CD34(+), CD34(+) CD38(-)], lymphoid [CD3(+), CD3(+) CD4(+), CD3(+) CD8(+)], and activated lymphoid cells [CD3(+) CD25(+), CD3(+) CD69(+), CD3(+) HLA-DR(+)] coexpressing CD3(+). There was substantial variability in the cellular composition of BM and PBPC grafts before and after graft processing by red blood cell (RBC) removal or plasma depletion in preparation for transplant. With BM grafts, cellular composition was not associated with hematopoietic recovery, graft-versus-host disease (GVHD), or survival. With PBPC grafts, survival rates were higher with CD34(+)>5 x 10(6)/kg, 59% compared to 34% with CD34(+)< or =5 x 10(6)/kg at 1 year. Platelet recovery was higher with PBPC containing CD3(+) CD8(+) >8 x 10(7)/kg. Neutrophil recovery or GVHD could not be predicted by any cellular subsets of PBPC grafts. Although survival was superior with PBPC grafts containing >5 x 10(6) CD34(+)/kg, an optimal graft mix of myeloid, lymphoid, and activated lymphoid subsets was not identified.
Collins
Nancy H
NH
Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Gee
Adrian P
AP
Durett
April G
AG
Kan
Fangyu
F
Zhang
Mei-Jie
MJ
Champlin
Richard E
RE
Confer
Dennis
D
Eapen
Mary
M
Howard
Alan
A
King
Roberta
R
Laughlin
Mary J
MJ
Plante
Robert J
RJ
Setterholm
Michelle
M
Spellman
Stephen
S
Keever-Taylor
Carolyn
C
Wagner
John E
JE
Weisdorf
Daniel J
DJ
D015703:Antigens, CD / Q000378:metabolism; D016026:Bone Marrow Transplantation / Q000379:methods / Q000401:mortality; D046148:Donor Selection; D005260:Female; D005434:Flow Cytometry; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D016130:Immunophenotyping; D007958:Leukocyte Count; D016131:Lymphocyte Subsets / Q000378:metabolism / Q000637:transplantation*; D008297:Male; D022423:Myeloid Cells / Q000145:classification / Q000378:metabolism / Q000637:transplantation*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D010641:Phenotype; D012042:Registries; D015203:Reproducibility of Results; D016019:Survival Analysis; D016896:Treatment Outcome
D015703:Antigens, CD