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Prepublished online as a Blood First Edition Paper on September 12, 2002; DOI 10.1182/blood-2002-05-1615.
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Blood, 15 January 2003, Vol. 101, No. 2, pp. 446-453
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Outcome of transplantation of highly purified peripheral blood
CD34+ cells with T-cell add-back compared with
unmanipulated bone marrow or peripheral blood stem cells from
HLA-identical sibling donors in patients with first chronic phase
chronic myeloid leukemia
Ahmet H. Elmaagacli,
Rudolf Peceny,
Nina Steckel,
Rudolf Trenschel,
Hellmut Ottinger,
Hans Grosse-Wilde,
Ulrich W. Schaefer, and
Dietrich W. Beelen
From the Department of Bone Marrow Transplantation and
the Institute of Immunology, University Hospital of Essen, Essen,
Germany.
Outcomes of highly purified CD34+ peripheral blood stem
cell transplantation (PBSCT) for chronic phase chronic myeloid leukemia (CML) (n = 32) were compared with those of PBSCT (n = 19) and of
bone marrow transplantation (BMT) (n = 22) in the
HLA-compatible sibling donor setting. Median follow-up was 18 months
after CD34+-PBSCT and unmanipulated PBSCT and 20 months
after BMT. CD34+-PBSCT was associated with delayed T-cell
immune reconstitution at 3 months and 12 months after transplantation
compared with PBSCT (P < .001) or BMT (not significant
[NS]). The estimated probability of grades II to IV acute
graft-versus-host disease (GVHD) was 60% ± 13% for the PBSCT group,
37% ± 13% for the BMT group, and only 14% ± 8% for the
CD34+-PBSCT group (CD34-PBSCT versus BMT,
P < .01; and CD34-PBSCT versus PBSCT,
P < .001). The probabilities for molecular relapse were 88% for CD34+-PBSCT, 55% after BMT, and 37% after
PBSCT (CD34+-PBSCT versus PBSCT,
P < .03). Cytogenetic relapse probability was 58% after
CD34+-PBSCT, 42% after BMT, and 28% after PBSCT (NS).
After CD34+-PBSCT, 26 of 32 patients received a
T-cell add-back. Hematologic relapse occurred in 4 of 22 patients after
BMT, in 3 of 19 patients after PBSCT, and in only 1 of 32 patients
after CD34+-PBSCT. The occurrence of a hematologic relapse
in patients receiving CD34+-PBSC transplants was prevented
by donor leukocyte infusions, which were applied at a median of 4 times
(range, 1-7 times) with a median T-cell dose of
3.3 × 106 × kg/body weight [at a median]
beginning at day 120 (range, 60-690 days). The estimated probability of
3-year survival after transplantation was 90% in the
CD34+-PBSCT group, 68% in the PBSCT group, and 63% in the
BMT group (CD34-PBSCT versus BMT, P < .01; and
CD34-PBSCT versus PBSCT, P < .03). Transplantation of
CD34+-PBSCs with T-cell add-back for patients with CML in
first chronic phase seems to be safe and is an encouraging alternative
transplant procedure to BMT or PBSCT.
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