T cell-depleted granulocyte colony-stimulating factor (G-CSF) modified allogenic bone marrow transplantation for hematological malignancy improves graft CD34+ cell content but is associated with delayed pancytopenia.

Abstract

To increase the stem cell content of T cell-depleted bone marrow transplants (BMT), we treated 12 patients with hematological malignancies with BMT from HLA-identical sibling donors given G-CSF 10 microg/kg/day for 5 days before marrow harvest. After CD34+ cell selection, patients received a median of 1.7 (range, 0.82-3.1) x 10(6) CD34+ cells/kg and 2.3 (range, 0.25-4.0) x 10(5) CD3+ cells/kg. All patients had initial engraftment but four developed pancytopenia between days 55-130 post-BMT. In two patients, this required a second infusion of G-CSF-mobilized donor peripheral blood progenitor cells. We observed no delayed pancytopenia in a matched historical group of 24 patients receiving T cell-depleted BMT without prior G-CSF stimulation. Compared to this control group, G-CSF-stimulated marrow recipients showed a significant decline in neutrophil and monocyte counts after 8 weeks. However, outcome after BMT was otherwise comparable, with a similar incidence of acute graft-versus-host disease and transplant-related mortality. Disease-free survival was 63 vs 67% for controls matched for CD34+ cell dose (P = NS). These results indicate that G-CSF stimulation can increase the CD34+ cell content of T cell-depleted marrow but carries a risk of late graft failure.

• Authors: D A Mavroudis, E J Read, J Molldrem, A Raptis, M Plante, C S Carter, S Phang, C E Dunbar, A J Barrett
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 21 Issue 5 Pg. 431-40 (Mar 1998) ISSN: 0268-3369 [Print] England
• PMID: 9535034 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antigens, CD34
• Granulocyte Colony-Stimulating Factor

Topics

• Adolescent
• Adult
• Antigens, CD34
• Bone Marrow Transplantation (adverse effects, methods)
• Cytomegalovirus (growth & development)
• Disease-Free Survival
• Erythrocyte Transfusion
• Female
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Hematologic Neoplasms (therapy)
• Hematopoietic Stem Cells
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (therapy)
• Leukocyte Count
• Male
• Middle Aged
• Myelodysplastic Syndromes (therapy)
• Pancytopenia (etiology)
• Platelet Transfusion
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (therapy)
• T-Lymphocytes
• Transplantation Conditioning
• Virus Activation