1. Effect of Autograft CD34+ Dose on Outcome in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplant for Central Nervous System Tumors.
- Author
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Knight, Tristan, Ahn, Kwang, Hebert, Kyle, Atshan, Rasha, Wall, Donna, Chiengthong, Kanhatai, Rotz, Seth, Fraint, Ellen, Rangarajan, Hemalatha, Auletta, Jeffery, Sharma, Akshay, Kitko, Carrie, Hashem, Hasan, Williams, Kirsten, Wirk, Baldeep, Myers, Kasiani, Pulsipher, Michael, Warwick, Anne, Schultz, Kirk, Qayed, Muna, Broglie, Larisa, Eapen, Mary, Yanik, Gregory, Dvorak, Christopher, and Lalefar, Nahal
- Subjects
Autograft ,Autologous hematopoietic stem cell transplant ,CD34+ ,Central nervous system ,Medulloblastoma ,TNC ,Humans ,Child ,Retrospective Studies ,Autografts ,Neoplasm Recurrence ,Local ,Hematopoietic Stem Cell Transplantation ,Antigens ,CD34 ,Central Nervous System Neoplasms - Abstract
Consolidation with autologous hematopoietic stem cell transplantation (HSCT) has improved survival for patients with central nervous system tumors (CNSTs). The impact of the autologous graft CD34+ dose on patient outcomes is unknown. We wanted to analyze the relationship between CD34+ dose, total nucleated cell (TNC) dose, and clinical outcomes, including overall survival (OS), progression-free survival (PFS), relapse, non-relapse mortality (NRM), endothelial-injury complications (EIC), and time to neutrophil engraftment in children undergoing autologous HSCT for CNSTs. A retrospective analysis of the CIBMTR database was performed. Children aged 3.6×106/kg CD34+ cells experienced superior PFS (p = .04) and OS (p = .04) compared to children receiving ≤3.6 × 106/kg. Relapse rates were lower in patients receiving >3.6 × 106/kg CD34+ cells (p = .05). Higher CD34+ doses were not associated with increased NRM (p = .59). Stratification of CD34+ dose by quartile did not reveal any statistically significant differences between quartiles for 3-year PFS (p = .66), OS (p = .29), risk of relapse (p = .57), or EIC (p = .87). There were no significant differences in patient outcomes based on TNC, and those receiving a TNC >4.4 × 108/kg did not experience superior PFS (p = .26), superior OS (p = .14), reduced risk of relapse (p = .37), or reduced NRM (p = .25). Children with medulloblastoma had superior PFS (p < .001), OS (p = .01), and relapse rates (p = .001) compared to those with other CNS tumor types. Median time to neutrophil engraftment was 10 days versus 12 days in the highest and lowest infused CD34+ quartiles, respectively. For children undergoing autologous HSCT for CNSTs, increasing CD34+ cell dose was associated with significantly improved OS and PFS, and lower relapse rates, without increased NRM or EICs.
- Published
- 2023