TY - JOUR
T1 - Allogeneic blood stem cell transplantation for refractory leukemia and lymphoma
T2 - Potential advantage of blood over marrow allografts
AU - Körbling, M.
AU - Przepiorka, D.
AU - Huh, Y. O.
AU - Engel, H.
AU - Van Besien, K.
AU - Giralt, S.
AU - Andersson, B.
AU - Kleine, H. D.
AU - Seong, D.
AU - Deisseroth, A. B.
AU - Andreeff, M.
AU - Champlin, R.
PY - 1995/3/15
Y1 - 1995/3/15
N2 - Peripheral blood stem cells (PBSCs) have been used rarely for allogeneic transplantation because of concerns regarding graft failure and graft- versus-host disease (GVHD). We evaluated the results of allogeneic PBSC transplantation (allo-PBSCT) in 9 patients with refractory leukemia or lymphoma receiving myeloablative therapy followed by allo-PBSCT from an HLA- identical sibling donor. Three patients had relapsed 11 to 21 months after allogeneic bone marrow transplantation (allo-BMT) and underwent allo-PBSCT using the same donor. Six patients received PBSCs as their initial allogeneic transplant. Filgrastim-mobilized PBSCs were collected from the donors in 3 to 4 aphereses and cryopreserved. The apheresis collections contained a median nucleated cell count of 16.5 x 108/kg (range, 10.8 to 28.7 x 108), 10.7 x 106 CD34+ cells/kg (range, 7.5 to 22.5 x 106), and 300.0 x 106 CD3+ cells/kg (range, 127.8 to 1,523.2 x 106). The median recovery of CD34+ progenitor cells after freezing, thawing, and washing was 106.4% (range, 36.7% to 132.0%). All patients received filgrastim posttransplant through engraftment, and cyclosporine and methylprednisolone were used for GVHD prophylaxis. Neutrophil recovery to greater than 0.5 x 109/L and greater than 1.0 x 109/L occurred at a median of 9 (range, 8 to 10) and 9 days (range, 8 to 11) posttransplant, respectively, which was similar to historical controls after allo-BMT and granulocyte colony-stimulating factor therapy. Platelets recovered to greater than 20 x 109/L and greater than 50 x 109/L at a median of 12 (range, 8 to 25) and 15 days (range, 11 to 59), respectively, which was significantly more rapid than for the controls (P < .01). Donor cell engraftment was documented by cytogenetics, fluorescence in situ hybridization, and/or restriction fragment length polymorphisms with longest follow-up of 283+ days. Three patients developed grade 2 acute GVHD involving only the skin. Three of five evaluable patients show limited chronic GVHD. Cryopreserved, filgrastim-stimulated allogeneic PBSCs may be a suitable alternative to allogeneic marrow for transplantation with the advantage of more rapid platelet recovery. Acute GVHD was minimal despite the infusion of 1 log more CD3 cells than with marrow allografts. Further studies are required to assess long-term risks of chronic GVHD.
AB - Peripheral blood stem cells (PBSCs) have been used rarely for allogeneic transplantation because of concerns regarding graft failure and graft- versus-host disease (GVHD). We evaluated the results of allogeneic PBSC transplantation (allo-PBSCT) in 9 patients with refractory leukemia or lymphoma receiving myeloablative therapy followed by allo-PBSCT from an HLA- identical sibling donor. Three patients had relapsed 11 to 21 months after allogeneic bone marrow transplantation (allo-BMT) and underwent allo-PBSCT using the same donor. Six patients received PBSCs as their initial allogeneic transplant. Filgrastim-mobilized PBSCs were collected from the donors in 3 to 4 aphereses and cryopreserved. The apheresis collections contained a median nucleated cell count of 16.5 x 108/kg (range, 10.8 to 28.7 x 108), 10.7 x 106 CD34+ cells/kg (range, 7.5 to 22.5 x 106), and 300.0 x 106 CD3+ cells/kg (range, 127.8 to 1,523.2 x 106). The median recovery of CD34+ progenitor cells after freezing, thawing, and washing was 106.4% (range, 36.7% to 132.0%). All patients received filgrastim posttransplant through engraftment, and cyclosporine and methylprednisolone were used for GVHD prophylaxis. Neutrophil recovery to greater than 0.5 x 109/L and greater than 1.0 x 109/L occurred at a median of 9 (range, 8 to 10) and 9 days (range, 8 to 11) posttransplant, respectively, which was similar to historical controls after allo-BMT and granulocyte colony-stimulating factor therapy. Platelets recovered to greater than 20 x 109/L and greater than 50 x 109/L at a median of 12 (range, 8 to 25) and 15 days (range, 11 to 59), respectively, which was significantly more rapid than for the controls (P < .01). Donor cell engraftment was documented by cytogenetics, fluorescence in situ hybridization, and/or restriction fragment length polymorphisms with longest follow-up of 283+ days. Three patients developed grade 2 acute GVHD involving only the skin. Three of five evaluable patients show limited chronic GVHD. Cryopreserved, filgrastim-stimulated allogeneic PBSCs may be a suitable alternative to allogeneic marrow for transplantation with the advantage of more rapid platelet recovery. Acute GVHD was minimal despite the infusion of 1 log more CD3 cells than with marrow allografts. Further studies are required to assess long-term risks of chronic GVHD.
UR - http://www.scopus.com/inward/record.url?scp=0028968604&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0028968604&partnerID=8YFLogxK
U2 - 10.1182/blood.v85.6.1659.bloodjournal8561659
DO - 10.1182/blood.v85.6.1659.bloodjournal8561659
M3 - Article
C2 - 7888684
AN - SCOPUS:0028968604
SN - 0006-4971
VL - 85
SP - 1659
EP - 1665
JO - Blood
JF - Blood
IS - 6
ER -