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Combined transplantation of allogeneic bone marrow and CD34+ blood cells
H Link, L Arseniev, O Bahre, RJ Berenson, K Battmer, JG Kadar, R Jacobs, J Casper, J Kuhl and J Schubert
Department of Hematology and Oncology, Medizinische Hochschule Hannover,
Germany.
Allogeneic peripheral blood progenitor cells (PBPCs) were transplanted
after immunoselection of CD34+ cells. Two patient groups were studied:
group I patients received immunoselected blood CD34+ cells and
unmanipulated marrow cells from the same donor. Group II patients were
given immunoselected blood and bone marrow (BM) CD34+ cells. One to 6 weeks
before bone marrow transplantation (BMT), PBPCs from HLA- identical and
MLC- sibling donors were mobilized with granulocyte colony-stimulating
factor (G-CSF) (5 micrograms/kg twice daily subcutaneously) for 5 days.
Aphereses were performed at days 4 and 5 of G-CSF application. CD34+ cells
were separated from the pooled PBPC concentrates by immunoadsorption onto
avidin with the biotinylated anti- CD34 monoclonal antibody 12.8 and then
stored in liquid nitrogen. BM was procured on the day of transplantation.
Patients were conditioned with either busulfan (16 mg/kg) or total body
irradiation (12 Gy) followed by cyclophosphamide (120 mg/kg). Cyclosporin A
and short methotrexate were used for graft-versus-host disease (GVHD)
prophylaxis. After transplantation, all patients received 5 micrograms
G-CSF/kg/d from day 1 until greater than 500 neutrophils/microL were
reached and 150 U erythropoietin/kg/d from day 7 until erythrocyte
transfusion independence for 7 days. Group I consisted of patients with
acute myeloid leukemia (AML) (n = 2), chronic myeloid leukemia (CML) (n =
2), and T-gamma-lymphoproliferative syndrome and BM aplasia (n = 1). The
patients received a mean of 3.3 x 10(6) CD34+ and 3.7 x 10(5) CD3+ cells/kg
body weight of PBPC origin and 4.5 x 10(6) CD34+ and 172 x 10(5) cells/kg
body weight of BM origin. Group II consisted of five patients (two AML, two
CML, one non-Hodgkin's lymphoma). They received a mean of 3.3 x 10(6) CD34+
and 3.2 x 10(5) CD3+ cells/kg from PBPC and 1.4 x 10(6) CD34+ and 0.6 x
10(5) CD3+ cells from BM. A matched historical control group (n = 12)
transplanted with a mean of 5.2 x 10(6) CD34+ and 156 x 10(5) CD3+ cells/kg
from BM alone was assembled for comparison. In group I, the median time to
neutrophil recovery to > 100, > 500, and > 1,000/microL was 12,
15, and 17 days, respectively. Patients from group II reached these
neutrophil levels at days 13, 15 and 17 post BMT. Neutrophil recovery in
the control patient group occurred at days 17, 18, and 20
respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
Volume 86,
Issue 7,
pp. 2500-2508,
10/01/1995
Copyright © 1995 by The American Society of Hematology
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