Role of CD34+ cells in engraftment after high-dose melphalan in multiple myeloma patients given peripheral blood stem cell rescue

B. C. Millar*, J. L. Millar, J. B G Bell, N. Raje, S. Milan, J. Mehta, S. Singhal, G. W. Middleton, V. Sheperd, D. Catovsky, R. L. Powles

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

During the period December 1992 to June 1995, 95 patients were treated with high-dose melphalan (HDM) with peripheral blood stem cell rescue (PBSCR). Sixty-five had received previous treatment and 28 had relapsed. Among patients who had relapsed 21/28 had received HDM previously including one who received HDM twice during the course of the study. Seventy-five patients were given HDM/PBSCR for the first time. Comparisons have been made between engraftment times for platelets and neutrophils among patients who received less than or greater than 2 x 106 CD34+ cells at rescue. Analyses have also been done to evaluate the effect of previous HDM on recovery. Mobilization of progenitor cells was done with granulocyte colony-stimulating factor (G-CSF). Patients received only PBSCR. No growth factors were given to the PBSCR recipients during the recovery period. The percentage of patients from whom the number of CD34+ cells mobilized was > 2 x 106/kg was similar in patients who received HDM for the first time (23%) compared with those who had had it previously (19%). The yield of CD341 cells correlated with the number of granulocyte-macrophage colony forming units (CFU-GM). Although the number of CD34+ cells infused was < 2 x 106/kg in 77% of patients, all engrafted for neutrophils to > 0.5 x 109/l. This was delayed in patients who had had previous HDM (P < 0.02). Platelet recovery to > 25, 50 and 100 x 109/l was delayed in all patients who received < 2 x 10 h CD34+ cells/kg infused (P < 0.02). In patients who had had previous HDM both neutrophil (P < 0.05) and platelet recovery (P < 0.007) were delayed compared with recovery in patients who had not had HDM. In patients who had had previous HDM and received < 2 x 106 CD34+ cells/kg infused only 3/17 regained platelets to > 100 x 109/l compared with 3/4 who had > 2 x 106 CD34+ cells/kg infused (P < 0.05 Fisher's exact test). There was no evidence that low numbers of CD34+ cells in the PBSCR were associated with early death. The data show that previous treatment with HDM had adverse effects on the subsequent engraftment of platelets among patients given HDM/PBSCR. The data suggest that additional measures are needed to achieve platelet reconstitution in these heavily pre-treated patients.

Original languageEnglish (US)
Pages (from-to)871-878
Number of pages8
JournalBone Marrow Transplantation
Volume18
Issue number5
StatePublished - Nov 1996

Keywords

  • CD34
  • Melphalan
  • Myeloma
  • Peripheral stem cells

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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