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Rapid engraftment without significant graft-versus-host disease after
allogeneic transplantation of CD34+ selected cells from peripheral blood
A Urbano-Ispizua, C Rozman, C Martinez, P Marin, J Briones, M Rovira, P Feliz, MC Viguria, A Merino, J Sierra, R Mazzara, E Carreras and E Montserrat
Department of Hematology and Postgraduate School of Hematology Farreras-
Valenti, Hospital Clinic, University of Barcelona, Spain.
We have prospectively evaluated the feasibility and results of the
biotin-avidin immunoadsorption method (Ceprate SC system) for a phase I/II
study of T-cell depletion of granulocyte colony-stimulating factor (G-CSF)
mobilized peripheral blood progenitor cells (PBPC) for allogeneic
transplantation. Twenty consecutive patients, median age, 40 years (21 to
54) and diagnoses of chronic myeloid leukemia in chronic phase (n = 5),
acute myeloblastic leukemia (n = 7), acute lymphoblastic leukemia (n = 2),
chronic myelomonocytic leukemia (n = 1), refractory anemia with excess of
blasts in transformation (n = 3), histiocytosis X (n = 1), and chronic
lymphocytic leukemia (n = 1), were conditioned with cyclophosphamide (120
mg/kg) and total body irradiation (13 Gy; 4 fractions). HLA identical
sibling donors received G-CSF at 10 microg/kg/d subcutaneously (SC); on
days 5 and 6 (19 cases) and days 5 to 8 (1 case) donors underwent 10 L
leukapheresis. PBPC were purified by positive selection of CD34+ cells
using immunoadsorption biotin- avidin method (Ceprate SC) and were infused
in the patients as the sole source of progenitor cells. No growth factors
were administered posttransplant. The median recovery of CD34+ cells after
the procedure was of 65%. The median number of CD34+ cells infused in the
patients was 2.9 (range, 1.5 to 8.6) x 10(6)/kg. The median number of CD3+
cells administered was 0.42 x 10(6)/kg (range, 0.1 to 2). All patients
engrafted. Neutrophil counts >500 and >1,000/microL were achieved at
a median of 14 days (range, 10 to 18) and 15 days (range, 11 to 27),
respectively. Likewise, platelet counts >20,000 and >50,000/microL
were observed at a median of 10 days (range, 6 to 23) and 17 days (range,
12 to 130), respectively. Graft-versus-host disease (GVHD) prophylaxis
consisted of cyclosporine plus methylprednisolone. No patient developed
either grade II to IV acute or extensive chronic GVHD. After a median
follow-up of 7.5 months (range, 2 to 22) three patients have relapsed, and
one of them is again in hematologic and cytogenetic remission after
infusion of the donor lymphocytes. Two patients died in remission: one on
day +109 of pulmonary aspergillosis and the other on day +251 of metastasic
relapse of a previous breast cancer. Sixteen of the 20 patients are alive
in remission after a median follow-up of 7.5 months (range, 2 to 22). In
conclusion, despite the small number of patients and limited follow-up, it
appears that this method allows a high CD34+ cell recovery from G-CSF
mobilized PBPC and is associated with rapid engraftment without significant
GVHD, and with low transplant related mortality.
Volume 89,
Issue 11,
pp. 3967-3973,
06/01/1997
Copyright © 1997 by The American Society of Hematology
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