Impact of CD34+ cell dose in children who receive unrelated PBSCT with in vivo T-cell depletion for hematologic malignancies

Bone Marrow Transplant. 2015 Jan;50(1):68-73. doi: 10.1038/bmt.2014.202. Epub 2014 Sep 29.

Abstract

PBSCs are increasingly being chosen as the mode of donation among unrelated donors. Pediatric patients, in particular, may receive very high CD34(+) and CD3(+) doses during unrelated PBSCT. In this work, we analyzed survival and GVHD outcomes in a cohort of 81 children who received unrelated PBSCT with uniform antithymocyte globulin (ATG)-based in vivo T-cell depletion for treatment of hematologic malignancy, with emphasis on the impact of cell dose on transplant outcomes. EFS was 61.5±5.6%, with higher CD34(+) dose (>10.0 × 10(6)/kg) and lower patient risk status predicting improved survival in multivariate study. Cumulative incidence of relapse was 30.2±5.2%; a low CD34(+) dose was the only significant factor for relapse. Neither CD34(+) nor CD3(+) dose was a significant determinant of acute or chronic GVHD. Importance of CD34(+) dose was reaffirmed in a subcohort of younger patients who received greater median cell doses than the overall cohort. In summary, for children who received unrelated PBSCT with ATG-based T-cell depletion for treatment of hematologic malignancy, the CD34(+) dose was the most important factor for relapse and EFS, and neither the CD34(+) nor the CD3(+) dose influenced incidence of acute or chronic GVHD.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Allografts
  • Antigens, CD34*
  • Antilymphocyte Serum / administration & dosage*
  • Child
  • Child, Preschool
  • Chronic Disease
  • Disease-Free Survival
  • Female
  • Graft vs Host Disease* / mortality
  • Graft vs Host Disease* / prevention & control
  • Hematologic Neoplasms* / metabolism
  • Hematologic Neoplasms* / therapy
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Infant
  • Lymphocyte Depletion*
  • Male
  • Peripheral Blood Stem Cell Transplantation*
  • Survival Rate

Substances

  • Antigens, CD34
  • Antilymphocyte Serum
  • Immunosuppressive Agents