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Optimizing the CD34 + cell dose for reduced-intensity allogeneic hematopoietic stem cell transplantation
Jayesh Mehta1, Jayesh Mehta, Olga Frankfurt
1The Feinberg School of Medicine, The Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. j-mehta@northwestern.edu
Leukemia & Lymphoma
|July 16, 2009
Summary
The optimal CD34+ cell dose for reduced-intensity allogeneic transplants is 6-8 x 10^6/kg ideal body weight. This dose range improves survival compared to lower or higher CD34+ cell doses, which are linked to increased mortality or graft-versus-host disease risk.
Area of Science:
- Hematology
- Transplantation Immunology
- Oncology
Background:
- CD34+ cell dose is critical in allogeneic transplantation, with low doses increasing mortality and high doses raising graft-versus-host disease risk.
- The optimal CD34+ cell dose for reduced-intensity allogeneic blood cell transplantation remains undetermined.
- Factors influencing transplant outcomes include chemosensitivity, donor age, LDH, HLA match, performance status, and platelet count.
Purpose of the Study:
- To determine the optimal CD34+ cell dose for reduced-intensity allogeneic blood cell transplantation.
- To analyze the effect of CD34+ cell dose based on ideal body weight on patient outcomes.
- To identify the relationship between CD34+ cell dose and survival rates in patients with hematologic malignancies.
Main Methods:
- Retrospective analysis of 130 patients with hematologic malignancies undergoing reduced-intensity allogeneic blood cell transplantation.
- Evaluation of CD34+ cell dose based on ideal body weight.
- Multivariable analysis incorporating factors like chemosensitivity, donor age, LDH, HLA match, performance status, and platelet count.
Main Results:
- Patients receiving 6-8 x 10^6/kg CD34+ cells showed significantly better outcomes than those receiving lower or higher doses.
- Survival was not significantly different between patients receiving >8 x 10^6/kg and <6 x 10^6/kg CD34+ cells.
- Among patients receiving <=8 x 10^6/kg CD34+ cells, higher infused cell counts correlated with improved overall survival (RR 0.8759; p=0.045).
- CD34+ cell dose based on actual weight did not correlate with survival.
Conclusions:
- The number of CD34+ cells infused is a modifiable factor impacting survival after reduced-intensity allogeneic transplantation.
- A recommended CD34+ cell dose of 6-8 x 10^6/kg ideal body weight optimizes outcomes.
- Further studies are needed to confirm the potential adverse effects of CD34+ cell doses exceeding 8 x 10^6/kg.
