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A Prospective Randomized Trial of Buffy Coat Versus CD34-Selected Autologous Bone Marrow Support in High-Risk Breast Cancer Patients Receiving High-Dose Chemotherapy
Elizabeth J. Shpall,
C. Fred LeMaistre,
Kent Holland,
Edward Ball,
Roy B. Jones,
Rein Saral,
Cindy Jacobs,
Shelly Heimfeld,
Ronald Berenson, and
Richard Champlin
From University of Colorado, Denver; University of Texas-San Antonio, San Antonio; Emory University, Atlanta, GA; University of Pittsburgh, Pittsburgh, PA; CellPro Inc, Bothell, WA; and University of Texas-MD Anderson Cancer Center, Houston.
High-dose chemotherapy with hematopoietic progenitor cell support is administered increasingly to selected categories of patients with high-risk malignancies. Bone marrow and/or peripheral blood progenitor cells (PBPCs) are commonly cryopreserved with the cryoprotectant dimethyl sulfoxide (DMSO), which can cause a variety of systemic side effects when the graft is thawed and infused. The progenitor cells thought to be responsible for hematopoietic recovery express the CD34 antigen and constitute 1% to 3% of the marrow cells and 0.5% of the PBPC fraction. Transplantation of a CD34+ graft would markedly reduce the volume and thus the amount of DMSO required, thereby decreasing the infusion-related toxicities. In this study, 89 high-risk breast cancer patients received high-dose therapy and were randomized to receive an autologous CD34+ marrow graft (Arm A) versus a standard buffy coat fraction (Arm B). After marrow infusion, significant increases in diastolic and systolic blood pressure, as well as significant decreases in heart rate, were documented in Arm B compared to Arm A patients (P < .001). None of the patients in Arm A experienced any clinically serious adverse events associated with the marrow infusion compared to 6% of the Arm B patients. The median time to neutrophil engraftment was 13 days for Arm A and 11 days for Arm B patients (P = .218). The median time to platelet engraftment was 27 days for Arm A and 20 days for Arm B patients (0.051). There were no other significant differences between the two arms of the study with respect to thrombocytopenia-related complications or immune function reconstitution. Additionally, patients on Arm A who received  1.2 × 106 CD34+ cells/kg had no delay in platelet recovery (22 days), compared to patients on Arm B, who also received greater than 1.2 × 106 CD34+ cells/kg (20 days) (P = .604). In conclusion, this prospective randomized study demonstrates that breast cancer patients who receive high-dose therapy with autologous CD34+ marrow support have reduced marrow infusion-related toxicity, comparable time to neutrophil engraftment and immune function recovery posttransplant, and for those who receive <1.2 × 106 CD34+ cells/kg, comparable time to platelet engraftment compared to women who receive buffy coat fractions of marrow.
Blood, Vol. 90 No. 11 (December 1), 1997:
pp. 4313-4320
© 1997 by The American Society of Hematology.
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