Allogeneic Blood Stem Cell Transplantation for Refractory Leukemia and Lymphoma: Potential Advantage of Blood Over Marrow Allografts

• Published in: Blood 1995-03, Vol.85 (6), p.1659-1665
• Main Authors: Körbling, M., Przepiorka, D., Huh, Y.O., Engel, H., Besien, K. van, Girait, S., Andersson, B., Kleine, H.D., Seong, D., Deisseroth, A.B., Andreeff, M., Champlin, R.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Female; Graft vs Host Disease - etiology; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cells - immunology; Humans; Immunophenotyping; Leukemia - therapy; Lymphoma - therapy; Male; Medical sciences; Middle Aged; Neoplasm, Residual; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V85.6.1659.bloodjournal8561659

Peripheral blood stem cells (PBSCs) have been used rarely for allogeneic transplantation because of concerns regarding graft failure and graft-versus-host disease (GVHD). We evaluated the results of allogeneic PBSC transplantation (allo-PBSCT) in 9 patients with refractory leukemia or lymphoma receiving myeloablative therapy followed by allo-PBSCT from an HLA-identical sibling donor. Three patients had relapsed 11 to 21 months after allogeneic bone marrow transplantation (allo-BMT) and underwent allo-PBSCT using the same donor. Six patients received PBSCs as their initial allogeneic transplant. Filgrastim-mobilized PBSCs were collected from the donors in 3 to 4 aphereses and cryopre-served. The apheresis collections contained a median nucleated cell count of 16.5 × 108/kg (range, 10.8 to 28.7 × 108), 10.7 × 106 CD34+ cells/kg (range, 7.5 to 22.5 × 106), and 300.0 × 108 CD3+ cells/kg (range, 127.8 to 1,523.2 × 106). The median recovery of CD34+ progenitor cells after freezing, thawing, and washing was 106.4% (range, 36.7% to 132.0%). All patients received filgrastim posttransplant through en-graftment, and cyclosporine and methylprednisolone were used for GVHD prophylaxis. Neutrophil recovery to greater than 0.5 × 109/L and greater than 1.0 × 109/L occurred at a median of 9 (range, 8 to 10) and 9 days (range, 8 to 11) posttransplant, respectively, which was similar to historical controls after allo-BMT and granulocyte colony-stimulating factor therapy. Platelets recovered to greater than 20 × 109/ L and greater than 50 × 109/L at a median of 12 (range, 8 to 25) and 15 days (range, 11 to 59), respectively, which was significantly more rapid than for the controls (P< .01). Donor cell engraftment was documented by cytogenetics, fluorescence in situ hybridization, and/or restriction fragment length polymorphisms with longest follow-up of 283+ days. Three patients developed grade 2 acute GVHD involving only the skin. Three of five evaluable patients show limited chronic GVHD. Cryopreserved, filgrastim-stimulated allogeneic PBSCs may be a suitable alternative to allogeneic marrow for transplantation with the advantage of more rapid platelet recovery. Acute GVHD was minimal despite the infusion of 1 log more CD3 cells than with marrow allografts. Further studies are required to assess long-term risks of chronic GVHD.