CD34(+)-selected stem cell boost without further conditioning for poor graft function after allogeneic stem cell transplantation in patients with hematological malignancies

Biol Blood Marrow Transplant. 2014 Mar;20(3):382-6. doi: 10.1016/j.bbmt.2013.11.034. Epub 2013 Dec 7.

Abstract

We retrospectively analyzed outcomes of a CD34(+)-selected stem cell boost (SCB) without prior conditioning in 32 patients (male/22; median age of 54 years; range, 20 to 69) with poor graft function, defined as neutrophils ≤1.5 x 10(9)/L, and/or platelets ≤30 x 10(9)/L, and/or hemoglobin ≤8.5 g/dL). The median interval between stem cell transplantation and SCB was 5 months (range, 2 to 228). The median number of CD34(+) and CD3(+) cells were 3.4 x 10(6)/kg (.96 to 8.30) and 9 x 10(3)/kg body weight (range, 2 to 70), respectively. Hematological improvement was observed in 81% of patients and noted after a median of 30 days (range, 14 to 120) after SCB. The recipients of related grafts responded faster than recipients of unrelated grafts (20 versus 30 days, P = .04). The cumulative incidence of acute (grade II to IV) and chronic graft-versus-host disease (GVHD) after SCB was 17% and 26%, respectively. Patients with acute GVHD received a higher median CD3(+) cell dose. The 2-year probability of overall survival was 45%. We suggest that SCB represents an effective approach to improve poor graft function post transplantation, but optimal timing of SCB administration, anti-infective, and GVHD prophylaxis needs further evaluation.

Keywords: Allogeneic hematopoietic stem cell transplantation (HSCT); CD34(+)-selected cells; Poor graft function; Stem cell boost.

MeSH terms

  • Acute Disease
  • Adult
  • Antigens, CD34 / immunology*
  • CD3 Complex / immunology
  • Chronic Disease
  • Female
  • Graft vs Host Disease / immunology
  • Graft vs Host Disease / mortality
  • Graft vs Host Disease / pathology
  • Graft vs Host Disease / therapy*
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / mortality
  • Hematologic Neoplasms / pathology
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Immunophenotyping
  • Male
  • Middle Aged
  • Neutrophils / cytology
  • Neutrophils / immunology
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Analysis
  • Transplantation, Homologous

Substances

  • Antigens, CD34
  • CD3 Complex