Low incidence of severe aGVHD and accelerating hemopoietic reconstitution in allo-BMT using lenograstim stimulated BM cells

OBJECTIVES: To investigate the efficacy of accelerating hemopoietic reconstraction and reducing a graft versus host disease (GVHD) in Allo-BMT receiving lenograstim stimulated donor marrow and to assess the preliminary biological mechanism. METHODS: The donors for thirty patients (study group) with leukemia were given lenograstim 3-4 micrograms.kg-1.d-1 for seven days prior to marrow harvest. The results of subsequent engraftment in the recipients was compared with fifteen donors without G-CSF (control group). Five donors themselves were studied to assess the effects of lenograstion on hematopoietic progenitor cells and lymphocyte subsets in BM. RESULTS: The stimulated bone marrow contained a higher number of nucleated cells, CFU-GM and CD34+ cells (P < 0.01). The hematopoetic reconstitution was accelerated. Until granulocyte counts exceeded 0.5 x 10(9)/L and plalete counts exceeded 20 x 10(9)/L, the days were 16.7 +/- 3.2 and 18.4 +/- 3.0 days as compared with those of the control group (22.5 +/- 5.1 and 26.3 +/- 5.9 days respectively, P < 0.01). The incidence of grade II-IV aGVHD was very low, only one case with grade II aGVHD on the skin in the study group. Four out of fifteen patients (26.7%) in the control group had grade II-IV aGVHD (P < 0.05). The number of T lymphocyte subsets in the harvested BM stimulated by G-CSF changed. In comparison with the control group, CD4+ decreased and CD8+ increased significantly (P < 0.01). The changes of progenitor cells and T lymphocyte subsets in BM from pre- to post-G-CSF stimulation indicated that the percentage of CD4+ cells reduced (P < 0.05), that of CD8+ cells, and that of CD34+ increased (P < 0.01). The incidence of chronic GVHD and relapse of leukemia were not different significantly between both groups. CONCLUSIONS: Allogenic bone marrow transplant (Allo-BMT) donors given G-CSF can accelerate engraftment and minimize the incidence of severe aGVHD. There is a trend in favour of improved transplant-related complications.