Impact of graft cell dose on transplant outcomes following unrelated donor allogeneic peripheral blood stem cell transplantation:: Higher CD34+ cell doses are associated with decreased relapse rates

被引:56
|
作者
Nakamura, Ryotaro [1 ]
Auayporn, Nademanee [1 ]
Smith, David D. [2 ]
Palmer, Joycelynne [2 ]
Sun, Joel Y. [1 ]
Schriber, Jeffrey [5 ]
Pullarkat, Vinod [1 ]
Parker, Pablo [1 ]
Rodriguez, Roberto [1 ]
Stein, Anthony [1 ]
Rosenthal, Joseph [1 ]
Wang, Shirong [3 ]
Karanas, Chatchada [1 ]
Gaal, Karl [4 ]
Senitzer, David [1 ]
Forman, Stephen J. [1 ]
机构
[1] City Hope Natl Med Ctr, Div Hematol Hematopoietic Cell Transplantat, Duarte, CA 91010 USA
[2] City Hope Natl Med Ctr, Dept Biostat, Duarte, CA 91010 USA
[3] City Hope Natl Med Ctr, Dept Transfus Med, Duarte, CA 91010 USA
[4] City Hope Natl Med Ctr, Dept Anat Pathol, Duarte, CA 91010 USA
[5] City Hope Samaritan Hematopoiet Cell Transplantat, Phoenix, AZ USA
关键词
unrelated donor; peripheral blood hematopoietic cell transplantation; CD34(+) cell dose;
D O I
10.1016/j.bbmt.2008.02.005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Peripheral blood stem cells (PBSC) have been increasingly used in the matched unrelated donor (MUD)transplant setting, but the impact of CD34(+) cell dose on outcomes in this setting have not been well characterized. We analyzed 181 consecutive patients who underwent MUD-PBSC transplantation at the City of Hope between August 2000 to December 2004. Patients were conditioned with either full-intensity regimen or reduced-intensity regimen. There was a significant inverse relationship between higher CD34(+) cell dose and faster neutrophil engraftment (r = -0.16, P = .035). By univariate analysis, a CD34(+) cell dose 4.2 x 10(6)/kg (above the lowest quartile) was associated with significantly lower relapse risk (hazard ratio [HR] = 0.67, P = .0126), with a trend for corresponding improvement for disease-free survival (HR = 0.84, P = .12) but not overall survival (HR = 0.91, P = .46). The impact of the CD34(+) cell dose remained significant in multivariate analysis. The higher CD34(+) cell dose was significantly associated with faster recovery of absolute lymphocyte counts on day +30 posttransplant. Subset analysis demonstrated that the higher CD34+ cell dose was associated with (1) greater reduction in relapse in myeloid malignancies than that in lymphoid malignancies, (2) greater reduction in reduced-intensity conditioning than in full-intensity conditioning, (3) greater reduction in relapse when there is a inhibitory killer-cell immunoglobulin-like receptor ligand (iKIRL)-mismatch in the gravft-versus-host (GVH) direction, and (4) greater reduction in relapse when there is a lack of iKIRL, suggesting that the protective effect of CD34+ cell dose against relapse may be immune-mediated, possibly through NK cell recovery. (c) 2008 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:449 / 457
页数:9
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