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Prepublished online as a Blood First Edition Paper on August 1, 2002; DOI 10.1182/blood-2002-01-0339.
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Blood, 1 December 2002, Vol. 100, No. 12, pp. 3930-3934
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Transplant-related mortality and long-term graft function are
significantly influenced by cell dose in patients undergoing allogeneic
marrow transplantation
Alida Dominietto,
Teresa Lamparelli,
Anna Maria Raiola,
Maria Teresa Van
Lint,
Francesca Gualandi,
Giovanni Berisso,
Stefania Bregante,
Carmen di
Grazia,
Monica Soracco,
Anna Pitto,
Francesco Frassoni, and
Andrea Bacigalupo
From the Dipartimento di Ematologia Ospedale San
Martino, Genova, Italy.
We have studied the impact of cell dose on short- and long-term
graft function and outcome in 905 patients undergoing an unmanipulated allogeneic bone marrow transplantation (BMT) from an
HLA-identical sibling (n = 735), a one-antigen mismatched related
donor (n = 35), or a matched unrelated donor (n = 135). Median
number of nucleated cells infused was 3.4 × 108/kg (25th
percentile 2.4 × 108/kg, 75th percentile 5 × 108/kg). Patients were stratified according to cells
infused in 3 groups:  2.4 × 108/kg (n = 247; low dose);
>2.4 × 108/kg and 5 × 108/kg (n = 452;
intermediate dose); and >5 × 108/kg (n = 206; high dose).
Patients receiving high cell dose had significantly higher platelet
counts on days +20, +50, +100, +180, and +365 after BMT (P < .01) and higher white blood cell counts on days +50, +100, and +180
after BMT (P < .01) as compared with other patients. The
actuarial 5-year transplant-related mortality (TRM) was 41% versus
36% versus 28% (P = .01); overall survival was 45%
versus 51% versus 56% (P = .0008); and disease-free
survival was 41% versus 42% versus 48%, respectively,
(P = .04) in patients receiving low, intermediate, or
high cell dose. The cell dose effect was more pronounced in patients
older than 30 years of age, with advanced disease, with chronic myeloid
leukemia, and with alternative donors. In multivariate Cox analysis on
TRM, cell dose was a significant predictor (P = .002;
relative risk 0.6) together with donor type (P = .0001),
year of transplantation (P = .0001), conditioning regimen
(P = .02), and recipient age (P = .02). In
conclusion, transplantation of high marrow cell dose is associated with
reduced transplant mortality and improved survival and results in
improved graft function both short and long term.
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