TY - JOUR
T1 - Allogeneic Blood Cell Transplantation Without Posttransplant Colony-Stimulating Factors in Patients with Hematopoietic Neoplasm
T2 - A Phase II Study
AU - Rosenfeld, Craig
AU - Collins, Robert
AU - Piñeiro, Luis
AU - Agura, Edward
AU - Nemunaitis, John
PY - 1996/4
Y1 - 1996/4
N2 - 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.
AB - 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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U2 - 10.1200/JCO.1996.14.4.1314
DO - 10.1200/JCO.1996.14.4.1314
M3 - Article
C2 - 8648389
AN - SCOPUS:0029979190
SN - 0732-183X
VL - 14
SP - 1314
EP - 1319
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 4
ER -