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Blood, 15 February 2006, Vol. 107, No. 4, pp. 1688-1695.
Prepublished online as a Blood First Edition Paper on August 30, 2005; DOI 10.1182/blood-2005-05-1897.
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Submitted May 10, 2005
Accepted August 22, 2005
Factors associated with early molecular remission following T cell depleted allogeneic stem cell transplantation for chronic myelogenous leukemia
Bipin N Savani, Katayoun Rezvani, Stephan Mielke, Aldemar Montero, Roger Kurlander, Charles S Carter, Susan Leitman, Elizabeth J Read, Richard Childs, and A J Barrett*
Hematology Branch, NHLBI, Bethesda, MD, USA
Department of Laboratory Medicine, NIH Clinical Center, Bethesda, MD, USA
NIH Clinical Center, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD, USA
* Corresponding author; email: barrettj{at}nhlbi.nih.gov.
Eighty patients with chronic myeloid leukemia (CML) received a T cell depleted stem cell transplant from an HLA identical sibling, with add-back of donor T cells on days 30-45 and day 60-100 in patients not developing grade  II acute GVHD. The outcomes for 54 chronic (CP) versus 26 advanced phase (AP) patients were respectively 85±5 vs 36±10%, overall survival; 13±5 vs 43±11%, TRM; and 76±6 vs 34±9% current LFS. The day 30 lymphocyte count (LC30) was strongly associated with outcome. For patients in CP with a count above the median of 300/µl, survival was 100 vs 70±9%; p=0.003; current LFS 100% vs 56±9%; p=0.002 and TRM 0% vs 26±8; p=0.006. Higher than median LC30 correlated significantly with molecular remission (MR) at 3, 6 and 12 months and with higher CD34 doses. Lymphocyte subset analysis performed in 20 cases available for phenotyping showed that LC30 was highly correlated with absolute CD56+ CD3- natural killer cell numbers (NK30) which also predicted for survival and MR. CD34 cell dose, LC30 and, NK30 but not day 30 CD3+ cell count were highly correlated and were significant predictors of transplant outcome. These results suggest that transplant CD34 cell doses of >5x106/kg may improve outcome by increasing early recovery of NK cells.
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