title: Clinical Relevance of Apheretic Graft Composition in Patients With Acute Myeloblastic Leukemia Who Received a Busulfan-Fludarabine-Antithymocyte Globulin Conditioning Regimen for Allogeneic Transplant.
abstract: OBJECTIVE
  Sparse data are available about the effects of apheretic graft composition on the clinical transplant outcome in allotransplanted patients who have hematologic malignant disease. Major obstacles in recent studies have included heterogeneity of patient populations and differences in the conditioning regimens used.
  
  
  METHODS
  This prospective study included 50 patients who had acute myeloblastic leukemia and received busulfan-fludarabine-antithymocyte globulin-based conditioning for peripheral allogeneic stem cell transplant. The concentration of CD34+ cells, T-cell subsets, B cells, and natural killer cells in the graft were analyzed by flow cytometry in the donors who were matched for human leukocyte antigen.
  
  
  RESULTS
  In univariate analysis, infusion with a higher dose of natural killer cells (> 1.55 × 106/kg) was associated with improved survival (P = .007 for disease-free survival; P = .024 for overall survival) in patients with acute myeloblastic leukemia. Cox regression models revealed that increased concentration of natural killer cells and CD34+ cells positively affected the clinical outcome of allotransplanted patients (P = .005 for both cell types). According to univariate analysis, these findings were dependent on minimal residual disease and acute graft-versus-host disease. Graft-versus-host disease (acute and chronic forms) was not affected by graft composition.
  
  
  CONCLUSIONS
  Our results suggest that increased concentration of natural killer cells and CD34+ cells in the apheretic product may predict better survival. In contrast, busulfan-fludarabine-antithymocyte globulin-based conditioning eliminates the disadvantages that resulted from the high content of T-cell subsets and B cells, and the course of the transplant and clinical parameters were not affected by the amount of T and B cells.
authors.affiliation: Baskent University Adana Adult Bone Marrow Transplantation Center, Adana, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yeral
authors.forename: Mutlu
authors.initials: M
authors.lastname: Kasar
authors.forename: Can
authors.initials: C
authors.lastname: Boga
authors.forename: Ilknur
authors.initials: I
authors.lastname: Kozanoglu
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozdogu
authors.forename: Cagla
authors.initials: C
authors.lastname: Sariturk
mesh_terms: D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis; D000961:Antilymphocyte Serum / Q000008:administration & dosage* / Q000009:adverse effects; D016175:B-Lymphocyte Subsets / Q000276:immunology / Q000637:transplantation*; D001781:Blood Component Removal; D002066:Busulfan / Q000008:administration & dosage* / Q000009:adverse effects; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D005434:Flow Cytometry; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007694:Killer Cells, Natural / Q000276:immunology / Q000637:transplantation*; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000637:transplantation*; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014421:Turkey; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D018952:Antigens, CD34; D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine