Higher Doses of CD34+Progenitors are Associated with Improved Overall Survival Without Increasing GVHD in Reduced Intensity Conditioning Allogeneic Transplant Recipients With Clinically Advanced Disease

ObjectiveThe influence of CD34+ cell dose on the outcome of allogeneic peripheral blood stem cell (PBSC) transplantation after reduced intensity conditioning (RIC) remains controversial. The impact of the number of CD34+ hematoprogenitors infused on transplant outcome and on the incidence of graft versus host disease (GVHD) was analyzed. Materials and methodsData of 138 patients with advanced hematological diseases who received an allogeneic PBSC transplant after RIC were analyzed. Donors were mobilized with granulocyte colony-stimulating factor and underwent one to three apheresis procedures. Incidence of acute and chronic GVHD and overall and event-free survival (OS and EFS) was determined. ResultsThe median number of CD34+ cells infused was 5.57x10(6) kg(-1) (range: 1.1-15.6). There was no relationship between CD34+ cell dose and neutrophil or platelet engraftment. Patients receiving 5x10(6) kg(-1) CD34+ cells had a 63.1% 5-year OS when compared with 48.2% for those receiving a lower number (P=0.024). At 5-year follow-up, there was no significant difference in EFS between the groups (44% vs. 42.8%, P=0.426). No relationship between CD34+ cell dose and acute GVHD was found (P=0.1). Relapse rate was the same in patients with and without acute GVHD (P=0.117). A nonsignificant improvement on OS and EFS in patients who developed chronic GVHD was found (P=0.57 and 0.41). ConclusionA CD34+ cell dose 5x10(6) kg(-1) was associated with a significantly higher OS, but no improved EFS in high-risk patients. The number of CD34+ progenitors infused had no influence on the incidence of acute or chronic GVHD. J. Clin. Apheresis 28:349-355, 2013. (c) 2013 Wiley Periodicals, Inc.