scholarly journals Allogeneic peripheral blood stem cell transplantation in patients with advanced hematologic malignancies: a retrospective comparison with marrow transplantation

Blood ◽  
1996 ◽  
Vol 88 (7) ◽  
pp. 2794-2800 ◽  
Author(s):  
WI Bensinger ◽  
R Clift ◽  
P Martin ◽  
FR Appelbaum ◽  
T Demirer ◽  
...  
Keyword(s):  
Stem Cell ◽  
Red Blood Cells ◽  
Peripheral Blood ◽  
Blood Cells ◽  
Marrow Transplantation ◽  
Acute Gvhd ◽  
Peripheral Blood Stem Cell ◽  
Chronic Gvhd ◽  
Hematologic Malignancies ◽  
Retrospective Comparison

Allogeneic peripheral blood stem cell (PBSC) transplants from HLA-identical siblings were performed in 37 patients with advanced hematologic malignancies. Outcomes were compared to a historical group of 37 similar patients with advanced hematologic malignancies receiving bone marrow (BM) transplants from HLA-identical donors. The PBSC group and historical BM group were well matched for diagnosis, disease stage, age, and graft-versus-host disease (GVHD) prophylaxis. Patients received PBSC transplants between 1993 to 1995 while BM patients were treated between 1989 to 1994. Engraftment, measured by the time to reach a peripheral neutrophil count > 500/L and platelet count > 20,000/microL without transfusions, occurred on days 14 and 11 in the patients transplanted with PBSC compared to days 16 and 15 in the patients receiving BM (P = .00063, .00014). The PBSC group required a median of 8 U of red blood cells and 24 U of platelets compared to 17 U of red blood cells and 118 U of platelets for BM transplant recipients (P = .0005, .0001). The estimated risks of developing grades 2 to 4 acute GVHD were 37% for the PBSC group and 56% for the BM group (P = .18), while the estimated risks of grades 3 to 4 acute GVHD were 14% for the PBSC group and 33% for the BM group, P = .05). Chronic GVHD occurred in 7 of 18 evaluable patients receiving PBSC and 6 of 23 evaluable patients receiving BM, P = .5. The estimated risks of transplant-related mortality at 200 days were 27% versus 45% (P = .33) relapse were 70% versus 53% (P = .27) and of overall survival were 50% and 41% (P = .39) for patients transplanted with PBSC or BM, respectively. This retrospective comparison suggests that compared to marrow transplantation from HLA-identical donors, allogeneic PBSC transplantation from HLA-identical donors is associated with faster engraftment, fewer transfusions, and no greater incidence of acute or chronic GVHD.

A Randomized, Double Blind Trial, of Hydroxychloroquine for the Prevention of Graft-Versus-Host Disease after Allogeneic Peripheral Blood Stem Cell Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1800-1800
Author(s):  
Tom Fong ◽  
Kim Trinkaus ◽  
Douglas R. Adkins ◽  
Ravi Vij ◽  
Steven Devine ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Graft Versus Host Disease ◽  
Peripheral Blood ◽  
Acute Gvhd ◽  
Peripheral Blood Stem Cell ◽  
Chronic Gvhd ◽  
Double Blind ◽  
Graft Versus Host ◽  
Blood Stem Cell Transplantation

Abstract Hydroxychloroquine (HCQ) is an immunosuppressive lysosomotropic amine that has activity against graft-versus-host disease (GVHD). We previously reported low incidences of acute GVHD in unrelated donor transplant recipients who received prophylactic HCQ in addition to standard GVHD prophylaxis (BBMT2003; 9: 714–721). We herein report results of a single-institution phase III trial, in which 95 recipients of matched sibling allogeneic peripheral blood stem cell transplantation were randomized to receive, in a double-blind fashion, and in addition to prophylactic cyclosporine A (CSA), HCQ or placebo starting 21 days pre-transplant and continued until d+365. HCQ was very well tolerated and not associated with side effects. The addition of HCQ had no effects on lymphocyte subsets both pre- and post-transplant. Overall, the incidence of acute GVHD was 59% in both arms, and severe acute GVHD occurred in 11% (HCQ) and 14% (placebo) (p=0.76). Sixty-one and 46% of patients developed chronic GVHD in the placebo and the HCQ arms, respectively (p = 0.15). With a median follow-up of 18 months, relapse-free and overall survivals were comparable in both groups. In summary, in this randomized trial, the addition of HCQ to single agent CSA was not associated with a reduction of either acute or chronic GVHD; additionally, no significant effects on relapses or survival were observed.

Poor harvest of peripheral blood stem cell in donors with microcytic red blood cells

Transfusion ◽  
2012 ◽  
Vol 53 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Tso-Fu Wang ◽  
Shu-Huey Chen ◽  
Shang-Hsien Yang ◽  
Yu-Chieh Su ◽  
Sung-Chao Chu ◽  
...  
Keyword(s):  
Stem Cell ◽  
Red Blood Cells ◽  
Peripheral Blood ◽  
Blood Cells ◽  
Peripheral Blood Stem Cell ◽  
Blood Stem Cell

Acute and Chronic Graft-Versus-Host Disease After Allogeneic Peripheral-Blood Stem-Cell and Bone Marrow Transplantation: A Meta-Analysis

2001 ◽  
Vol 19 (16) ◽  
pp. 3685-3691 ◽  
Author(s):  
Corey Cutler ◽  
Satyendra Giri ◽  
Suriya Jeyapalan ◽  
David Paniagua ◽  
Akila Viswanathan ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Bone Marrow Transplantation ◽  
Graft Versus Host Disease ◽  
Peripheral Blood ◽  
Marrow Transplantation ◽  
Peripheral Blood Stem Cell ◽  
Meta Analysis ◽  
Chronic Gvhd ◽  
Graft Versus Host

PURPOSE: Controversy exists as to whether the incidence of graft-versus-host disease (GVHD) is increased after peripheral-blood stem-cell transplantation (PBSCT) when compared with bone marrow transplantation (BMT). We performed a meta-analysis of all trials comparing the incidence of acute and chronic GVHD after PBSCT and BMT reported as of June, 2000. Secondary analyses examined relapse rates after the two procedures. METHODS: An extensive MEDLINE search of the literature was undertaken. Primary authors were contacted for clarification and completion of missing information. A review of cited references was also undertaken. Sixteen studies (five randomized controlled trials and 11 cohort studies) were included in this analysis. Data was extracted by two pairs of reviewers and analyzed for the outcomes of interest. Meta-analyses, regression analyses, and assessments of publication bias were performed. RESULTS: Using a random effects model, the pooled relative risk (RR) for acute GVHD after PBSCT was 1.16 (95% confidence interval [CI], 1.04 to 1.28; P= .006) when compared with traditional BMT. The pooled RR for chronic GVHD after PBSCT was 1.53 (95% CI, 1.25 to 1.88; P < .001) when compared with BMT. The RR of developing clinically extensive chronic GVHD was 1.66 (95% CI, 1.35 to 2.05; P < .001). The excess risk of chronic GVHD was explained by differences in the T-cell dose delivered with the graft in a meta-regression model that did not reach statistical significance. There was a trend towards a decrease in the rate of relapse after PBSCT (RR = 0.81; 95% CI, 0.62 to 1.05). CONCLUSION: Both acute and chronic GVHD are more common after PBSCT than BMT, and this may be associated with lower rates of malignant relapse. The magnitude of the transfused T-cell load may explain the differences in chronic GVHD risk.

Hematopoietic Stem Cell Transplantation (HSCT) for Benign Indications Using Umbilical Cord Blood Units (UCB) That Were Depleted of Plasma, but Not of Red Blood Cells.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5459-5459
Author(s):  
Robert Chow ◽  
Tang-Her Jaing ◽  
David Gjertson ◽  
Joseph Rosenthal ◽  
Auayporn Nademanee ◽  
...  
Keyword(s):  
Stem Cell ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Disease Free Survival ◽  
Critical Factor ◽  
Cell Loss ◽  
Hematopoietic Stem ◽  
Benign Disorders

Abstract Background: UCB is an attractive unrelated source for HSCT of benign indications such as hemoglobinapathies, genetic diseases and metabolic disorders, because of less stringent HLA matching requirements, lower incidence and severity of GvHD, and ready availability of a physical inventory; however, unlike BMT or PSCT, cell dosage is a critical factor in success of UCB HSCT. The red cell depletion (RCD) techniques that are widely used by UCB banks incur significant nucleated cell loss after processing. One method of minimizing cell loss during processing is to deplete plasma, but not the red blood cells (PD). A large racially diverse PD UCB inventory of 18,000 units is now available on stem cell registries. We now report our observations of using unrelated PD UCB HSCT for benign indications. Hypothesis: Usage of unrelated PD UCB for HSCT of benign indications will result in acceptable clinical outcome for myeloid (ANC 500) and platelet engraftment, overall survival (OS), and transplant related mortality (TRM). Methods: A retrospective analysis was performed on 28 patients with benign disorders who were transplanted with PD UCB in 15 centers and 7 countries, with 13 thalassemias, 5 SAA, 5 WAS, 2 SCID, 1 sickle cell disease, 1 osteopetrosis and 1 metabolic disorder. Results: The median age of patients was 3.7 years old (range 03–27 years old); median weight 16.0 kg (range 4.5–43 kg); male 57%. Transplant characteristics indicated a median # HLA ABDR matches of 4.0 (5 6/6; 7 5/6; 12 4/6; 3 3/6; 1NA); median pre-freeze TNC dose 7.7 x 107/kg; median post-thaw TNC dose as reported by TC 7.7 x 107/kg; median pre-freeze CD34 dose 3.1 x 105/kg; transplants performed outside of U.S. 68%; double unit transplant 13%; non-myeloablative 6%. The median time to engraftment for ANC 500 (n=21), platelet 20K (n=20), and 50K (n=18) are 14.5 days (range 11–41 days), 47.0 days (range 13–82 days), and 55.0 days (range 21–96 days) respectively. The unadjusted cumulative incidence (C.I.) of ANC500 and platelet 20K and 50K engraftment are 89±7%, 89±7%, and 87±8% respectively. The incidence of reported grade II–IV acute GVHD was 33%, and none had grade III–IV acute GVHD. 50% developed limited chronic GVHD (7/14), and so far only one patient was reported to have extensive chronic GVHD. With a median follow-up of 356 days (range 93–1,100 days), the Kaplan-Meier estimates of 1-year TRM, OS and disease-free survival were 11±6%, 89±6% and 89±6% respectively. Conclusion: These results demonstrate that HSCT using unrelated PD UCB can be performed safely and effectively in patients with benign disorders. Further study of HSCT using unrelated PD UCB in patients with non-malignant hematological disorders is warranted.

scholarly journals A retrospective comparison of allogeneic peripheral blood stem cell versus bone marrow transplantation

2009 ◽  
Vol 2 (1) ◽  
pp. 272-277 ◽  
Author(s):  
Henrique Bittencourt ◽  
Monalisa Lopes ◽  
Antonio Vaz de Macedo ◽  
Elen Rose Teixeira ◽  
Gabriel Gomes Sabido Gomes ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Bone Marrow Transplantation ◽  
Peripheral Blood ◽  
Marrow Transplantation ◽  
Peripheral Blood Stem Cell ◽  
Blood Stem Cell ◽  
Retrospective Comparison ◽  
Cell Versus

scholarly journals Reduced Dose of Post-Transplant Cyclophosphamide for HLA Haploidentical Peripheral Blood Stem Cell Transplantation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5698-5698
Author(s):  
Satoshi Morishige ◽  
Yoshitaka Yamasaki ◽  
Shuki Oya ◽  
Takayuki Nakamura ◽  
Maki Ymaguchi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Acute Gvhd ◽  
Peripheral Blood Stem Cell ◽  
Hematologic Malignancies ◽  
Hematopoietic Stem ◽  
Reduced Dose ◽  
Kaplan Meier

Abstract [Introduction] Allogeneic hematopoietic stem cell transplantation (Allo-SCT) remains the only potentially curative therapy for patients with high-risk or chemo-refractory hematologic malignancies. Recently, various methods including post-transplant cyclophosphamide (PT-CY) showed the ability to overcome the HLA disparity barrier and haploidentical hematopoietic stem cell transplantation (haplo-SCT) have been becoming an attractive method of transplantation with less rejection or graft-versus-host disease (GVHD). There have been many reports that the outcomes of haplo-SCT are equivalent to those of matched related donors and matched unrelated donors. The standard dose of PT-CY is 50 mg/kg/day for 2 days. However, optimal dose of PT-CY has not been studied extensively. In this study, we performed a clinical study of reduced dose of PT-CY (40 mg/kg/day for 2 days) haplo-SCT for hematologic malignancies. [Methods] We included adult patients with hematologic malignancies who received haplo-SCT at Kurume university hospital, Kurume, Japan between Oct 2014 and March 2018. Myeloablative conditioning (MAC) regimen consisted of fludarabine (Flu) (30 mg/m2 for 5 days), busulfan (BU) (3.2 mg/kg/day for 4 days) and total-body irradiation (TBI) 4Gy (Flu/BU4/TBI4Gy) or Flu (30 mg/m2 for 3 days) and TBI 12Gy (Flu/TBI12Gy). Reduced-intensity conditioning (RIC) regimen consisted of Flu (30 mg/m2 for 5 days), BU (3.2 mg/kg/day for 2 days) and TBI 4Gy (Flu/BU2/TBI4Gy). All patients were given PT-CY (40 mg/kg/day) on day +3 and day +4, followed by tacrolimus and mycophenolate mofetil (MMF) starting on day + 5 for GVHD prophylaxis. If there was no active GVHD, MMF was tapered off from day +30. Filgrastim 300 ug/m2 was administered starting on day +5 and continuing until neutrophil engraftment was achieved. Donors were mobilized with filgrastim 400 ug/m2 for 4 or 5 days, the peripheral blood stem cells were collected with one or two apheresis procedures. OS and PFS were calculated using the Kaplan-Meier method and the log-rank test was used for comparisons of Kaplan-Meier curves. Estimates of acute GVHD was calculated using death as the competing risk. P-values <0.05 were considered statistically significant. [Results] A total 15 patients with acute myeloid leukemia (AML, n=6), myelodysplastic syndrome (MDS, n=2), acute lymphoblastic leukemia (ALL, n=4), adult T-cell leukemia/lymphoma (ATLL, n=1) and malignant lymphoma (ML, n=2) were analyzed in this study. Patients median age was 54 years (range, 17 to 72); 9 patients were male, and 6 patients were female. Eight patients received MAC, 7 received RIC conditioning regimen. Disease status at transplantation was complete remission (CR) in 8 patients, non-CR in 7. The median CD34+ cell dose was 5.9 x 106 /kg (range, 2.4 to 17.4). All 15 patients achieved a neutrophil engraftment in a median 15 days (range, 13 to 19). Grade II-IV and III-IV acute GVHD occurred in 46.7% (95% confidence interval [CI], 14.4-66.8) and in 13.3% (95% CI, 0-28.9) patients, respectively. At 2 years, overall survival (OS) and progression-free survival were 36.6% (95% CI, 13.0-60.9) and 32.0% (95% CI, 10.9-55.7), respectively. The 2-years OS of patients in CR before SCT was 50.0% (95% CI, 15.2-77.5) compared to 28.6% (95% CI, 4.1-61.2) not in CR (P=0.106). The causes of death were: disease progression (n = 3), infection (n = 3), acute GVHD (n = 2), and noninfectious pulmonary complications (n = 2). Among infectious complications, two were bacterial infections and one was BK virus-associated hemorrhagic cystitis. [Conclusion] Reduced dose of PT-CY HLA haploidentical peripheral blood stem cell transplantation resulted in acceptable rate and severity of acute GVHD. However, relapse and infection remain major problems after PT-CY haplo-SCT for hematologic malignancies. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document