CD34+ selected stem cell boosts can improve poor graft function after paediatric allogeneic stem cell transplantation. (3rd December 2017)

• Record Type: Journal Article
• Authors: Mainardi, Chiara; Ebinger, Martin; Enkel, Sigrid; Feuchtinger, Tobias; Teltschik, Heiko‐Manuel; Eyrich, Matthias; Schumm, Michael; Rabsteyn, Armin; Schlegel, Patrick; Seitz, Christian; Schwarze, Carl‐Phillip; Müller, Ingo; Greil, Johann; Bader, Peter; Schlegel, Paul‐Gerhardt; Martin, David; Holzer, Ursula; Döring, Michaela; Handgretinger, Rupert; Lang, Peter
• Is Part Of: British journal of haematology. Volume 180:Number 1(2018)
• Page Start: 90
• Page End: 99
• Publication Date: 2017-12-03
• Subjects: stem cell boost -- poor graft function -- haematopoietic stem cell transplantation -- haematopoietic recovery; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.15012
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Poor graft function (PGF) is a severe complication of haematopoietic stem cell transplantation (HSCT) and administration of donor stem cell boosts (SCBs) represents a therapeutic option. We report 50 paediatric patients with PGF who received 61 boosts with CD34 + selected peripheral blood stem cells (PBSC) after transplantation from matched unrelated ( n = 25) or mismatched related ( n = 25) donors. Within 8 weeks, a significant increase in median neutrophil counts (0·6 vs. 1·516 × 10 9 /l, P < 0·05) and a decrease in red blood cell and platelet transfusion requirement (median frequencies 1 and 7 vs. 0, P < 0·0001 and <0·001), were observed, and 78·8% of patients resolved one or two of their cytopenias. 36·5% had a complete haematological response. Median lymphocyte counts for CD3 +, CD3 + CD4 +, CD19 + and CD56 + increased 8·3‐, 14·2‐, 22.‐ and 1·6‐fold. The rate of de novo acute graft‐versus‐host disease (GvHD) grade I–III was only 6% and resolved completely. No GvHD grade IV or chronic GvHD occurred. Patients who responded to SCB displayed a trend toward better overall survival (OS) ( P = 0·07). Thus, administration of CD34 + selected SCBs from alternative donors is safe and effective. Further studies are warranted to clarify the impact on immune reconstitution and survival.