Peripheral blood stem cell CD34+ autologous transplant in relapsed follicular lymphoma |
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Authors: | G H Marin L Dal Cortivo J M Cayuela J P Marolleau P Pautier I Cojean-Zelek P Brice J Makke M Benbunan C Gisselbrecht |
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Institution: | (1) Service de Réanimation Hématologie Adulte, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, F-75475 Paris cedex 10, France;(2) Centre de Secteur d’Hemobiologie Transfusion Sanguine, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, F-75475 Paris cedex 10, France;(3) Laboratoire Central d’Hématologie, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, F-75475 Paris cedex 10, France;(4) Institut Gustave Roussy, 39, rue Camille Desmoulins, F-94805 Villejuif cedex, France;(5) Hôpital de Jour d’Hématologie, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, F-75475 Paris cedex 10, France |
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Abstract: | To evaluate CD34+ selection of peripheral blood stem cells (PBSC) as a graft for autologous transplantation. Eight relapsing follicular lymphoma (FL) patients were submitted to CD34+ autologous stem cell transplantation (ASCT). All patients received at least two front line conventional therapies; mean time to treatment failure (TTF) was 4.5 months. Patients had disseminated stage III-IV disease after a median number of 2.1 relapses. Chemotherapy and G-CSF were used as mobilization for leukapheresis. CEPRATE SC concentrator (CellPro, Inc, Bothell, WA) was used to select CD34+ cells from leukapheresis products. With a mean of 1.8 leukaphereses per patient, 8.1 × 108 mononuclear cells (MNCs)/kg were collected. After the selection process, the median number of MNCs was 9.4 × 106/kg; 4.3 × 106/kg CD34+ cells and 17 × 104/kg CFU-GM, with a purity of 83.7% and a viability of 89.2%. Mbr bcl2/IgH PCR analysis of 5 grafts showed that initial buffy-coat, and CD34- fractions were negative in 3 cases and positive in 2 cases (from whom selected CD34+ fraction remained positive in 1 case). After a conditioning regimen including total body irradiation, cyclophosphamide and etoposide, CD34+ selected cells were reinfused. All patients but one had successful engraftment, median time to WBC > 1 × 109/l was 12 days and platelets > 50 × 109/l 17 days. No severe infectious complications were seen. After transplant, with a minimum follow up of 2 years, 5 patients are still in complete remission (CR). Three patients have relapsed after 1 year of transplant with a mean TTF of 15.6 months. We conclude that PBSC CD34+ selection for ASCT was a safe technique, capable of reconstituting hemopoiesis without severe complications for high risk FL patients included in this study. The effects of tumor cell purging need to be evaluated in a larger series.Research grant support from CellPro, Bothwel, WA, USA |
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Keywords: | Follicular lymphoma CD34 selection Peripheral blood stem cells |
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