title: Higher doses of CD34+ progenitors are associated with improved overall survival without increasing GVHD in reduced intensity conditioning allogeneic transplant recipients with clinically advanced disease.
abstract: OBJECTIVE
  The influence of CD34+ cell dose on the outcome of allogeneic peripheral blood stem cell (PBSC) transplantation after reduced intensity conditioning (RIC) remains controversial. The impact of the number of CD34+ hematoprogenitors infused on transplant outcome and on the incidence of graft versus host disease (GVHD) was analyzed.
  
  
  METHODS
  Data of 138 patients with advanced hematological diseases who received an allogeneic PBSC transplant after RIC were analyzed. Donors were mobilized with granulocyte colony-stimulating factor and underwent one to three apheresis procedures. Incidence of acute and chronic GVHD and overall and event-free survival (OS and EFS) was determined.
  
  
  RESULTS
  The median number of CD34+ cells infused was 5.57 × 10(6) kg(-1) (range: 1.1-15.6). There was no relationship between CD34+ cell dose and neutrophil or platelet engraftment. Patients receiving ≥5 × 10(6) kg(-1) CD34+ cells had a 63.1% 5-year OS when compared with 48.2% for those receiving a lower number (P = 0.024). At 5-year follow-up, there was no significant difference in EFS between the groups (44% vs. 42.8%, P = 0.426). No relationship between CD34+ cell dose and acute GVHD was found (P = 0.1). Relapse rate was the same in patients with and without acute GVHD (P = 0.117). A nonsignificant improvement on OS and EFS in patients who developed chronic GVHD was found (P = 0.57 and 0.41).
  
  
  CONCLUSIONS
  A CD34+ cell dose ≥5 × 10(6) kg(-1) was associated with a significantly higher OS, but no improved EFS in high-risk patients. The number of CD34+ progenitors infused had no influence on the incidence of acute or chronic GVHD.
authors.affiliation: Internal Medicine Division, Hematology Department, "Dr. José Eleuterio González" University Hospital, School of Medicine of the Autonomous University of Nuevo León, Monterrey, México.
authors.forename: David
authors.initials: D
authors.lastname: Gómez-Almaguer
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Gómez-Peña
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Jaime-Pérez
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Gómez-Guijosa
authors.forename: Olga
authors.initials: O
authors.lastname: Cantú-Rodríguez
authors.forename: Homero
authors.initials: H
authors.lastname: Gutiérrez-Aguirre
authors.forename: Sylvia Aidé
authors.initials: SA
authors.lastname: Martínez-Cabriales
authors.forename: Fernando
authors.initials: F
authors.lastname: García-Rodríguez
authors.forename: Leticia A
authors.initials: LA
authors.lastname: Olguín-Ramírez
authors.forename: Rosario
authors.initials: R
authors.lastname: Salazar-Riojas
authors.forename: Nereida
authors.initials: N
authors.lastname: Méndez-Ramírez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism*; D001781:Blood Component Removal; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D016179:Granulocyte Colony-Stimulating Factor / Q000378:metabolism; D006680:HLA Antigens / Q000378:metabolism; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D013234:Stem Cells / Q000166:cytology*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D006680:HLA Antigens; D016179:Granulocyte Colony-Stimulating Factor
keywords: CD34+ cell dose; CD34+ hematoprogenitors; peripheral blood stem cell transplantation; reduced intensity conditioning