Optimizing the CD34 + cell dose for reduced-intensity allogeneic hematopoietic stem cell transplantation

Jayesh Mehta*, Olga Frankfurt, Jessica Altman, Andrew Evens, Martin Tallman, Leo Gordon, Stephanie Williams, Jane Winter, Jairam Krishnamurthy, Sara Duffey, Veerpal Singh, Richard Meagher, David Grinblatt, Lynne Kaminer, Seema Singhal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Low CD34 + cell doses increase allograft-related mortality and very high doses increase the risk of graft-versus-host disease. The optimum CD34 + cell dose remains undefined. The effect of the CD34 + cell dose based on ideal weight was analyzed in 130 patients with hematologic malignancies undergoing reduced-intensity allogeneic blood cell transplantation in the context of factors known to affect the outcome: chemosensitivity, donor age, lactate dehydrogenase (LDH), human leukocyte antigen (HLA) match, performance status, and platelet count. The survival of patients receiving >8 × - 10 6/kg CD34 + cells was not significantly different from those receiving <6. The outcome of those receiving 6 8 × - 106/kg CD34 + cells was significantly better than the rest. This superiority was confirmed in multivariable analysis. Among patients receiving ≤ 8 × - 106/kg CD34 + cells, an increasing number of infused cells was associated with higher overall survival in a continuous fashion (Risk ratio (RR) 0.8759; p = 0.045). Cell dose based on actual weight did not correlate with survival. The number of CD34 + cells infused, a potentially modifiable factor, affects survival after reduced-intensity allogeneic transplantation. We recommend a CD34 + cell dose of 6 8 × - 106 per kg ideal body weight to optimize outcome. The possible adverse effect of higher cell doses (>8) needs further confirmation.

Original languageEnglish (US)
Pages (from-to)1434-1441
Number of pages8
JournalLeukemia and Lymphoma
Volume50
Issue number9
DOIs
StatePublished - 2009

Keywords

  • Allogeneic transplantation
  • CD34 cell dose
  • blood
  • transplant-related mortality

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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