Low CD34 Dose Is Associated with Poor Survival after Reduced-Intensity Conditioning Allogeneic Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndrome |
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| Affiliation: | 1. Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden;2. Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden;3. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin;4. Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin;5. Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland;6. Department of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts;7. Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas;8. Division of Hematology & Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;9. Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia;10. Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio;11. Stem Cell Therapeutics Program, Novartis Pharmaceuticals Inc, East Hanover, New Jersey;12. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California;13. Centre for Children''s Cancer & Blood Disorders, Sydney Children''s Hospital, Sydney, NSW, Australia;14. Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;15. Department of Clinical Haematology, Churchill Hospital, Oxford University Hospital, Oxford, United Kingdom;16. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;17. Department of Hematology, University of Manitoba, Winnipeg, Manitoba, Canada;18. Department of Hematology, Hospital Vall d’Hebron, Barcelona, Spain |
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| Abstract: | Reduced-intensity conditioning/nonmyeloablative conditioning regimens are increasingly used in allogeneic hematopoietic cell transplantation (HCT). Reports have shown CD34+ dose to be important for transplantation outcome using myeloablative conditioning. The role of CD34+ dose of peripheral blood progenitor cells (PBPC) has not been previously analyzed in a large population undergoing reduced-intensity conditioning/nonmyeloablative HCT. We studied 1054 patients, ages 45 to 75 years, with acute myeloid leukemia or myelodysplastic syndrome who underwent transplantation between 2002 and 2011. Results of multivariate analysis showed that PBPC from HLA-matched siblings containing <4 × 106 CD34+/kg was associated with higher nonrelapse mortality (hazard ratio [HR], 2.03; P = .001), overall mortality (HR, 1.48; P = .008), and lower neutrophil (odds ratio [OR], .76; P = .03) and platelet (OR, .76; P = .03) recovery. PBPC from unrelated donors with CD34+ dose < 6 × 106 CD34+/kg was also associated with higher nonrelapse (HR, 1.38; P = .02) and overall mortality (HR, 1.20; P = .05). In contrast to reports after myeloablative HCT, CD34+ dose did not affect relapse or graft-versus-host disease with either donor type. An upper cell dose limit was not associated with adverse outcomes. These data suggest that PBPC CD34+ doses >4 × 106 CD34+/kg and >6 × 106 CD34+/kg are optimal for HLA-matched sibling and unrelated donor HCT, respectively. |
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| Keywords: | Cellular content Peripheral blood graft Hematological malignancy |
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