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Prepublished online as a Blood First Edition Paper on October 10, 2002; DOI 10.1182/blood-2002-04-1203.
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Blood, 15 February 2003, Vol. 101, No. 4, pp. 1630-1636
TRANSPLANTATION
Transplantation of highly purified CD34+ progenitor
cells from unrelated donors in pediatric leukemia
Peter Lang,
Rupert Handgretinger,
Dietrich Niethammer,
Paul G. Schlegel,
Michael Schumm,
Johann Greil,
Peter Bader,
Corinna Engel,
Hans Scheel-Walter,
Matthias Eyrich, and
Thomas Klingebiel
From the Children's University Hospital, University of
Tuebingen, Germany; Institute for Biostatistics,
University of Tuebingen, Germany; Children's University
Hospital, University of Wuerzburg, Germany; and
Children's University Hospital, University of Frankfurt, Frankfurt,
Germany.
Unrelated donors are commonly used for hematopoietic stem cell
transplants, but graft-versus-host disease (GVHD) is a major problem.
We investigated whether transplantation of purified mobilized peripheral-blood CD34+ stem cells from unrelated donors
would prevent acute and chronic GVHD in pediatric patients with
leukemia and avert the need for pharmacologic immunosuppression.
Thirty-one pediatric patients with acute lymphoblastic leukemia (ALL,
n = 16), acute myeloid (n = 7), chronic myeloid (n = 6), or
juvenile myelomonocytic leukemia (n = 2) underwent transplantation.
The median purity of CD34+ cells after positive
magnet-activated cell sorting was 98.5%. Patients received a median of
8.0 × 106 CD34+ cells and
6 × 103 CD3+ T lymphocytes per kilogram,
with no posttransplantation pharmacologic immunosuppression. Primary
acute GVHD  grade II was seen in only 10% of patients (n = 3)
and occurred only after human herpesvirus 6 (HHV 6) infection. Two
patients had limited chronic GVHD. Engraftment occurred in all patients
(primary engraftment, n = 26; engraftment after reconditioning,
n = 5). The 2-year survival estimate was 38% for all patients and
63% for patients with ALL in complete remission. Patients with myeloid
malignancies had a poor outcome. In comparison to a historical control
group who received unmanipulated bone marrow, our patients had a lower
incidence of GVHD (P < .001). No difference was observed
in the probability of relapse or survival. Study patients with ALL in
remission showed a trend toward better survival
(P = .07). Transplantation of purified peripheral-blood CD34+ cells from unrelated donors effectively minimizes
GVHD and may be a good therapeutic option for patients with relapsed ALL.
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