Allogeneic Blood Cell Transplantation Without Posttransplant Colony-Stimulating Factors in Patients with Hematopoietic Neoplasm

A Phase II Study

Craig Rosenfeld, Robert Collins, Luis Piñeiro, Edward Agura, John Nemunaitis

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose: There is limited experience with allogeneic blood cell transplantation (BCT). In an earlier pilot study, the combination of bone marrow and blood did not produce severe acute graft-versus-host disease (GVHD). We now report the results of a phase II study using blood stem cells alone in 19 patients. Patients and Methods: The median age was 40 years. All patients had hematopoietic malignancies and received transplants from HLA-identical sibling donors. GVHD prophylaxis consisted of cyclosporine plus prednisone. Posttransplant colony-stimulating factors were not administered. Donors were mobilized with subcutaneous granulocyte colony-stimulating factor (G-CSF; 16 μg/ kg/d) for 5 days. Apheresis was performed on 2 consecutive days. Results: The median cell content of the two apheresis was 11.9 × 108 WBC/kg, 3.2 × 108 CD3/kg, and 8.3 × 106 CD34/kg. The median time to achieve an absolute neutrophil count (ANC) ≥ 500/μL was 13 days, and 14 days to a platelet count ≥ 50,000/μL. All patients engrafted. Platelet recovery was faster than in marrow historic control groups. Blood cells in all tested cases contained more than 95% donor cells on day 30. The actuarial incidence of acute GVHD was 37%, and 13% for grade II-IV GVHD. Limited, corticosteroid responsive, chronic GVHD developed in 33% of assessable patients. At a median follow-up of 192 days, actuarial survival was 75%. Conclusion: Transplantation of a high number of stem cells may lead to rapid engraftment without the use of posttransplant colony-stimulating factors. GVHD does not appear to be more severe than in similarly treated patients undergoing bone marrow transplantation. For allogeneic transplantation, mobilized blood cell collections are an alternative to bone marrow collections.

Original languageEnglish (US)
Pages (from-to)1314-1319
Number of pages6
JournalJournal of Clinical Oncology
Volume14
Issue number4
StatePublished - Apr 1996

Fingerprint

Colony-Stimulating Factors
Cell Transplantation
Graft vs Host Disease
Hematologic Neoplasms
Blood Cells
Blood Component Removal
Bone Marrow
Tissue Donors
Granulocyte Colony-Stimulating Factor
Stem Cells
Homologous Transplantation
Prednisone
Bone Marrow Transplantation
Platelet Count
Cyclosporine
Siblings
Adrenal Cortex Hormones
Neutrophils
Blood Platelets
Transplantation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Allogeneic Blood Cell Transplantation Without Posttransplant Colony-Stimulating Factors in Patients with Hematopoietic Neoplasm : A Phase II Study. / Rosenfeld, Craig; Collins, Robert; Piñeiro, Luis; Agura, Edward; Nemunaitis, John.

In: Journal of Clinical Oncology, Vol. 14, No. 4, 04.1996, p. 1314-1319.

Research output: Contribution to journalArticle

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abstract = "Purpose: There is limited experience with allogeneic blood cell transplantation (BCT). In an earlier pilot study, the combination of bone marrow and blood did not produce severe acute graft-versus-host disease (GVHD). We now report the results of a phase II study using blood stem cells alone in 19 patients. Patients and Methods: The median age was 40 years. All patients had hematopoietic malignancies and received transplants from HLA-identical sibling donors. GVHD prophylaxis consisted of cyclosporine plus prednisone. Posttransplant colony-stimulating factors were not administered. Donors were mobilized with subcutaneous granulocyte colony-stimulating factor (G-CSF; 16 μg/ kg/d) for 5 days. Apheresis was performed on 2 consecutive days. Results: The median cell content of the two apheresis was 11.9 × 108 WBC/kg, 3.2 × 108 CD3/kg, and 8.3 × 106 CD34/kg. The median time to achieve an absolute neutrophil count (ANC) ≥ 500/μL was 13 days, and 14 days to a platelet count ≥ 50,000/μL. All patients engrafted. Platelet recovery was faster than in marrow historic control groups. Blood cells in all tested cases contained more than 95{\%} donor cells on day 30. The actuarial incidence of acute GVHD was 37{\%}, and 13{\%} for grade II-IV GVHD. Limited, corticosteroid responsive, chronic GVHD developed in 33{\%} of assessable patients. At a median follow-up of 192 days, actuarial survival was 75{\%}. Conclusion: Transplantation of a high number of stem cells may lead to rapid engraftment without the use of posttransplant colony-stimulating factors. GVHD does not appear to be more severe than in similarly treated patients undergoing bone marrow transplantation. For allogeneic transplantation, mobilized blood cell collections are an alternative to bone marrow collections.",
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