Faculty Collaboration Database

CD3+ cell dose and disease status are important factors determining clinical outcomes in patients undergoing unmanipulated haploidentical blood and marrow transplantation after conditioning including antithymocyte globulin. Biol Blood Marrow Transplant 2007 Dec;13(12):1515-24

Date

11/21/2007

Pubmed ID

18022582

DOI

10.1016/j.bbmt.2007.09.007

Scopus ID

2-s2.0-36048971099 (requires institutional sign-in at Scopus site)   33 Citations

Abstract

Haploidentical transplantation is a feasible alternative for patients with life-threatening hematologic diseases who lack a matched donor. Factors affecting the clinical outcomes of haploidentical transplantation remain under investigation. We analyzed 157 consecutive patients with leukemia who underwent transplantation with nonmanipulated granulocyte colony-stimulating factor (G-CSF)-mobilized marrow and peripheral blood cells (G-BMPBs) from haploidentical donors after receiving myeloablative chemotherapy (Ara-C + BuCy + antithymocyte globulin). Follow up observations after transplantation were made from 48 days to 1191 days (median, 448 days). Multivariate analysis indicated that the cohort given higher doses of CD3(+) cells (> or = 177 x 10(6) /kg) in allograft transplantation had a significantly lower treatment-related mortality (TRM) (relative risk [RR] = 0.35; 95% CI = 0.16-0.77; P = .0090), better leukemia-free survival (LFS) (RR = 0.46; 95% CI = 0.26-0.84; P = .0106), and better overall survival (OS) (RR = 0.42; 95% CI = 0.23-0.78; P = .0058). Inversely, advanced-stage disease was a strong predictor of greater posttransplantation relapse (RR = 3.48; 95% CI = 1.26- 9.60; P = .0159), worse LFS (RR = 2.56; 95% CI = 1.33-4.95; P = .0050), and worse OS (RR = 2.77; 95% CI = 1.39-5.53; P = .0038). A high number of CD3(+) cells (> 177 x 10(6)/kg) given to patients resulted in statistically less TRM and more intensive graft versus leukemia effect without producing more severe grades of GVHD, all resulting in a significantly better overall clinical outcome from haploidentical transplantation.

Author List

Dong L, Wu T, Zhang MJ, Gao ZY, Lu DP

Author

Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Antilymphocyte Serum
Bone Marrow Transplantation
CD3 Complex
Child
China
Disease-Free Survival
Female
Follow-Up Studies
Graft vs Leukemia Effect
HLA Antigens
Haploidy
Hematopoietic Stem Cell Transplantation
Humans
Kaplan-Meier Estimate
Leukemia
Male
Middle Aged
Myelodysplastic Syndromes
Peripheral Blood Stem Cell Transplantation
T-Lymphocyte Subsets
Transplantation Conditioning
Transplantation, Homologous