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A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: should 2 x 10(6) CD34+ cells/kg be considered the minimum threshold?
Bone Marrow Transplant. 2000 Sep; 26(5):489-96.BM

Abstract

We studied the effect of the CD34+ cell dose on transplant-related mortality (TRM) and survival in 39 patients randomized to receive lenograstim-mobilized PBSCT (n = 20) or BMT (n = 19) from HLA-identical siblings. Both marrow and blood were harvested, and one infused in a double-blind fashion. The median nucleated (7.0 vs 3.2 x 10(8)/kg; P < 0.0001), CD34+ (3.7 vs 1.5 x 10(6)/kg; P = 0.002), CFU-GM (42 vs 19 x 10(4)/kg; P = 0.002), and CD3+ (1.9 vs 0.3 x 10(8)/kg; P < 0.0001) cell doses with PBSCT were higher. Thirteen patients (6 BMT and 7 PBSCT) experienced TRM at 15-733 days (median 57); 10 of 20 receiving <2 x 10(6) CD34+ cells/kg compared with three of 19 receiving > or =2. Eight of 20 patients receiving <2 x 10(6) CD34+ cells/kg are alive compared with 14 of 19 receiving > or =2. In Cox analysis, CD34+ cell dose > or =2 x 10(6)/kg was associated with lower TRM (RR 0.2, P = 0.01), and higher overall (RR 3.7, P = 0.01) and event-free (RR 3.2, P = 0.02) survival. Other cell populations and the source of stem cells did not affect TRM or survival. We conclude that 2 x 10(6) CD34+ cells/kg may be the ideal minimum cell dose for allogeneic transplantation although lower doses do not preclude successful therapy. Since the likelihood of obtaining this threshold CD34+ cell number is significantly greater from blood than marrow, PBSCT may be preferable to marrow for allografts from HLA-identical siblings.

Authors+Show Affiliations

Leukaemia Unit, Royal Marsden Hospital, Surrey, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11019837

Citation

Singhal, S, et al. "A Low CD34+ Cell Dose Results in Higher Mortality and Poorer Survival After Blood or Marrow Stem Cell Transplantation From HLA-identical Siblings: Should 2 X 10(6) CD34+ Cells/kg Be Considered the Minimum Threshold?" Bone Marrow Transplantation, vol. 26, no. 5, 2000, pp. 489-96.
Singhal S, Powles R, Treleaven J, et al. A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: should 2 x 10(6) CD34+ cells/kg be considered the minimum threshold? Bone Marrow Transplant. 2000;26(5):489-96.
Singhal, S., Powles, R., Treleaven, J., Kulkarni, S., Sirohi, B., Horton, C., Millar, B., Shepherd, V., Tait, D., Saso, R., Rowland, A., Long, S., & Mehta, J. (2000). A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: should 2 x 10(6) CD34+ cells/kg be considered the minimum threshold? Bone Marrow Transplantation, 26(5), 489-96.
Singhal S, et al. A Low CD34+ Cell Dose Results in Higher Mortality and Poorer Survival After Blood or Marrow Stem Cell Transplantation From HLA-identical Siblings: Should 2 X 10(6) CD34+ Cells/kg Be Considered the Minimum Threshold. Bone Marrow Transplant. 2000;26(5):489-96. PubMed PMID: 11019837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: should 2 x 10(6) CD34+ cells/kg be considered the minimum threshold? AU - Singhal,S, AU - Powles,R, AU - Treleaven,J, AU - Kulkarni,S, AU - Sirohi,B, AU - Horton,C, AU - Millar,B, AU - Shepherd,V, AU - Tait,D, AU - Saso,R, AU - Rowland,A, AU - Long,S, AU - Mehta,J, PY - 2000/10/6/pubmed PY - 2001/3/17/medline PY - 2000/10/6/entrez SP - 489 EP - 96 JF - Bone marrow transplantation JO - Bone Marrow Transplant. VL - 26 IS - 5 N2 - We studied the effect of the CD34+ cell dose on transplant-related mortality (TRM) and survival in 39 patients randomized to receive lenograstim-mobilized PBSCT (n = 20) or BMT (n = 19) from HLA-identical siblings. Both marrow and blood were harvested, and one infused in a double-blind fashion. The median nucleated (7.0 vs 3.2 x 10(8)/kg; P < 0.0001), CD34+ (3.7 vs 1.5 x 10(6)/kg; P = 0.002), CFU-GM (42 vs 19 x 10(4)/kg; P = 0.002), and CD3+ (1.9 vs 0.3 x 10(8)/kg; P < 0.0001) cell doses with PBSCT were higher. Thirteen patients (6 BMT and 7 PBSCT) experienced TRM at 15-733 days (median 57); 10 of 20 receiving <2 x 10(6) CD34+ cells/kg compared with three of 19 receiving > or =2. Eight of 20 patients receiving <2 x 10(6) CD34+ cells/kg are alive compared with 14 of 19 receiving > or =2. In Cox analysis, CD34+ cell dose > or =2 x 10(6)/kg was associated with lower TRM (RR 0.2, P = 0.01), and higher overall (RR 3.7, P = 0.01) and event-free (RR 3.2, P = 0.02) survival. Other cell populations and the source of stem cells did not affect TRM or survival. We conclude that 2 x 10(6) CD34+ cells/kg may be the ideal minimum cell dose for allogeneic transplantation although lower doses do not preclude successful therapy. Since the likelihood of obtaining this threshold CD34+ cell number is significantly greater from blood than marrow, PBSCT may be preferable to marrow for allografts from HLA-identical siblings. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/11019837/A_low_CD34+_cell_dose_results_in_higher_mortality_and_poorer_survival_after_blood_or_marrow_stem_cell_transplantation_from_HLA_identical_siblings:_should_2_x_10_6__CD34+_cells/kg_be_considered_the_minimum_threshold L2 - http://dx.doi.org/10.1038/sj.bmt.1702542 DB - PRIME DP - Unbound Medicine ER -