A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: Should 2 x 106 CD34+ cells/kg be considered the minimum threshold?

S. Singhal, R. Powles, J. Treleaven, S. Kulkarni, B. Sirohi, C. Horton, B. Millar, V. Shepherd, D. Tait, R. Saso, A. Rowland, S. Long, J. Mehta

Research output: Contribution to journalArticle

74 Scopus citations

Abstract

We studied the effect of the CD34+ cell dose on transplant-related mortality (TRM) and survival in 39 patients randomized to receive lenograstim-mobilized PBSCT (n = 20) or BMT (n = 19) from HLA-identical siblings. Both marrow and blood were harvested, and one infused in a double-blind fashion. The median nucleated (7.0 vs 3.2 x 108/kg; P < 0.0001), CD34+ (3.7 vs 1.5 x 106/kg; P = 0.002), CFU-GM (42 vs 19 x 104/kg; P = 0.002), and CD3+ (1.9 vs 0.3 x 108/kg; P < 0.0001) cell doses with PBSCT were higher. Thirteen patients (6 BMT and 7 PBSCT) experienced TRM at 15-733 days (median 57); 10 of 20 receiving <2 x 106 CD34+ cells/kg compared with three of 19 receiving ≥ 2. Eight of 20 patients receiving <2 x 106 CD34+ cells/kg are alive compared with 14 of 19 receiving ≥ 2. In Cox analysis, CD34+ cell dose ≥ 2 x 106/kg was associated with lower TRM (RR 0.2, P = 0.01), and higher overall (RR 3.7, P = 0.01) and event-free (RR 3.2, P = 0.02) survival. Other cell populations and the source of stem cells did not affect TRM or survival. We conclude that 2 x 106 CD34+ cells/kg may be the ideal minimum cell dose for allogeneic transplantation although lower doses do not preclude successful therapy. Since the likelihood of obtaining this threshold CD34+ cell number is significantly greater from blood than marrow, PBSCT may be preferable to marrow for allografts from HLA-identical siblings.

Original languageEnglish (US)
Pages (from-to)489-496
Number of pages8
JournalBone Marrow Transplantation
Volume26
Issue number5
DOIs
StatePublished - 2000

Keywords

  • Allogeneic transplantation
  • Bone marrow
  • CD34
  • G-CSF
  • Lenograstim
  • Leukemia

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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