Impact of Graft Cell Dose on Transplant Outcomes following Unrelated Donor Allogeneic Peripheral Blood Stem Cell Transplantation: Higher CD34+ Cell Doses Are Associated with Decreased Relapse Rates

Peripheral blood stem cells (PBSC) have been increasingly used in the matched unrelated donor (MUD) transplant setting, but the impact of CD34⁺ cell dose on outcomes in this setting have not been well characterized. We analyzed 181 consecutive patients who underwent MUD-PBSC transplantation at the City of Hope between August 2000 to December 2004. Patients were conditioned with either full-intensity regimen or reduced-intensity regimen. There was a significant inverse relationship between higher CD34⁺ cell dose and faster neutrophil engraftment (r = −0.16, P = .035). By univariate analysis, a CD34⁺ cell dose ≥4.2 × 10⁶/kg (above the lowest quartile) was associated with significantly lower relapse risk (hazard ratio [HR] = 0.67, P = .0126), with a trend for corresponding improvement for disease-free survival (HR = 0.84, P = .12) but not overall survival (HR = 0.91, P = .46). The impact of the CD34⁺ cell dose remained significant in multivariate analysis. The higher CD34⁺ cell dose was significantly associated with faster recovery of absolute lymphocyte counts on day +30 posttransplant. Subset analysis demonstrated that the higher CD34⁺ cell dose was associated with (1) greater reduction in relapse in myeloid malignancies than that in lymphoid malignancies, (2) greater reduction in reduced-intensity conditioning than in full-intensity conditioning, (3) greater reduction in relapse when there is a inhibitory killer-cell immunoglobulin-like receptor ligand (iKIRL)-mismatch in the gravft-versus-host (GVH) direction, and (4) greater reduction in relapse when there is a lack of iKIRL, suggesting that the protective effect of CD34⁺ cell dose against relapse may be immune-mediated, possibly through NK cell recovery.