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Higher doses of CD34+ peripheral blood stem cells are associated with increased mortality from chronic graft-versus-host disease after allogeneic HLA-identical sibling transplantation.

Authors :
Mohty, M.
Bilger, K.
Jourdan, E.
Kuentz, M.
Michallet, M.
Bourhis, J. H.
Milpied, N.
Sutton, L.
Jouet, J. P.
Attal, M.
Bordigoni, P.
Cahn, J. Y.
Sadoun, A.
Ifrah, N.
Guyotat, D.
Faucher, C.
Fegueux, N.
Reiffers, J.
Maraninchi, D.
Blaise, D.
Source :
Leukemia (08876924); May2003, Vol. 17 Issue 5, p869, 7p
Publication Year :
2003

Abstract

Allogeneic peripheral blood stem cell transplantation (PBSCT) has emerged as an alternative to bone marrow transplantation. PBSCT can be associated with a higher incidence of chronic graft-versus-host disease (cGVHD). In this study, we investigated whether there was a correlation between the composition of PBSC grafts (CD34+ and CD3+ cells) and hematological recovery, GVHD, relapse, and relapse-free survival (RFS) after myeloablative HLA-identical sibling PBSCT. The evolution of 100 acute or chronic leukemia patients was analyzed. Neither hematological recovery, acute or cGVHD, nor relapse, was significantly associated with CD3+ cell dose. Increasing CD34+ stem cells was associated with faster neutrophil (P=0.03) and platelet (P=0.007) recovery. Moreover, 47 of the 78 patients evaluable for cGVHD (60%; 95% CI, 49-71%) developed extensive cGVHD. The probability of extensive cGVHD at 4 years was 34% (95% CI, 21-47%) in patients receiving a 'low' CD34+ cell dose (<8.3×10[SUP6]/kg), as compared to 62% (95% CI, 48-76%) in patients receiving a 'high' CD34+ cell dose (>8.3×10[SUP6]/kg) (P=0.01). At a median follow-up of 59 months, this has not translated into a difference in relapse. In patients evaluable for cGVHD, RFS was significantly higher in patients receiving a 'low' CD34+ cell dose as compared to those receiving a 'high' CD34+ cell dose (P=0.04). This difference was mainly because of a significantly higher cGVHD-associated mortality (P=0.01). Efforts to accelerate engraftment by increasing CD34+ cell dose must be counterbalanced with the risk of detrimental cGVHD. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
08876924
Volume :
17
Issue :
5
Database :
Complementary Index
Journal :
Leukemia (08876924)
Publication Type :
Academic Journal
Accession number :
9761160
Full Text :
https://doi.org/10.1038/sj.leu.2402909