Hematopoietic recovery in cancer patients after transplantation of autologous peripheral blood CD34+ cells or unmanipulated peripheral blood stem and progenitor cells

• Published in: Transfusion (Philadelphia, Pa.) Vol. 38; no. 2; pp. 199 - 208
• Main Authors: Beguin, Y., Baudoux, E., Sautois, B., Fraipont, V., Schaaf-Lafontaine, N., Pereira, M., Paulus, J.M., Sondag, D., Fillet, G.
• Format: Journal Article Web Resource
• Language: English
• Published: Edinburgh, UK Blackwell Science Ltd 01.02.1998; Blackwell Publishing; American Association of Blood Banks
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD34; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Differentiation; Cell Division; Hematology; Hematopoiesis; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cells - pathology; Human health sciences; Humans; Hématologie; Medical sciences; Neoplasms - therapy; Sciences de la santé humaine; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous; Short term; Human; Evaluation; Autograft; Blood cell; Cancerology; Indication; Stem cell; Treatment efficiency; Transplantation; Long term; Biological activity
• ISSN: 0041-1132; 1537-2995; 1537-2995
• DOI: 10.1046/j.1537-2995.1998.38298193106.x

BACKGROUND: A study of CD34+ cell selection and transplantation was carried out with particular emphasis on characteristics of short‐ and long‐term hematopoietic recovery. STUDY DESIGN AND METHODS: Peripheral blood stem and progenitor cells (PBPCs) were collected from 32 patients, and 17 CD34+ cell‐selection procedures were carried out in 15 of the 32. One patient in whom two procedures failed to provide 1 × 10(6) CD34+ cells per kg was excluded from further analysis. After conditioning, patients received CD34+ cells (n = 10, CD34 group) or unmanipulated (n = 17, PBPC group) PBPCs containing equivalent amounts of CD34+ cells or progenitors. RESULTS: The yield of CD34+ cells was 53 percent (18–100) with a purity of 63 percent (49–82). The CD34+ fraction contained 66 percent of colony‐forming units‐granulocyte‐ macrophage (CFU‐GM) and 58 percent of CFU of mixed lineages, but only 33 percent of burst‐forming units‐erythroid (BFU‐E) (p < 0.05). Early recovery of neutrophils and reticulocytes was identical in the two groups, although a slight delay in platelet recovery may be seen with CD34+ cell selection. Late hematopoietic reconstitution, up to 1.5 years after transplant, was also similar. The two groups were thus combined for analyses of dose effects. A dose of 40 × 10(4) CFU‐GM per kg ensured recovery of neutrophils to a level of 1 × 10(9) per L within 11 days, 15 × 10(4) CFU of mixed lineages per kg was associated with platelet independence within 11 days, and 100 × 10(4) BFU‐E per kg predicted red cell independence within 13 days. However, a continuous effect of cell dose well beyond these thresholds was apparent, at least for neutrophil recovery. CONCLUSION: CD34+ cell selection, despite lower efficiency in collecting BFU‐E, provides a suitable graft with hematopoietic capacity comparable to that of unmanipulated PBPCs. In both groups, all patients will eventually show hematopoietic recovery of all three lineages with 1 × 10(6) CD34+ cells per kg or 5 × 10(4) CFU‐GM per kg, but a dose of 5 × 10(6) CD34+ cells or 40 × 10(4) CFU‐GM per kg is critical to ensure rapid recovery.