CD34+ Enriched Allo BMT, Unrelated Donors, At Higher Risk

[Guest guest]

British Journal of Haematology

Volume 118 Issue 4 Page 1095 - September 2002

CD34+-enriched peripheral blood progenitor cells from

unrelated donors for allografting of adult patients:

high risk of graft failure, infection and relapse

despite donor lymphocyte add-back

Bornhäuser, Uwe Platzbecker, Catrin Theuser, K.

Hölig and Gerhard Ehninger

Summary. Fifty-one adults with hematological

malignancies were transplanted with CD34+-selected

peripheral blood progenitor cells (PBPC) from

unrelated donors.

The conditioning protocol contained total body

irradiation (n=17) or combinations of busulphan and

other alkylating agents (n=34). Antithymocyte globulin

was infused in all patients.

The median number of CD3+ T cells infused with the

graft after purification with the Isolex 300® system

in the first cohort of 18 patients was 2·1105/kg.

Prophylactic donor lymphocyte infusion (DLI)

containing 1105CD3+ T cells was performed on d21 in

the following 33 patients who had received PBPC

purified by the CliniMACS® system.

Early graft failure occurred in 8/51 patients (16%).

After a median follow-up of 31months (range 8-60), the

probability of disease-free survival (DFS) was 36% for

the whole group. Reasons for death were opportunistic

infections (n=15), graft-versus-host disease (GvHD,

n=7) and relapse (n=4). Pre-transplant factors with

significant impact on DFS were cytomegalovirus status

and risk category of underlying disease. The

occurrence of graft failure or GvHD was associated

with poor outcome.

Recipients of CD34+-selected PBPC from unrelated

donors are at high risk of infectious complications,

relapse and graft failure which cannot be prevented by

early reinfusion of unmodified donor lymphocytes.

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