Related Experiment Videos
Allogeneic peripheral blood stem cell transplantation using normal patient-related pediatric donors
M Körbling1, K W Chan, P Anderlini
1Department of Hematology and Pediatrics, University of Texas MD Anderson Cancer Center, Houston 77030, USA.
Insights
Allogeneic peripheral blood progenitor cell (PBPC) transplantation using pediatric donors is safe and effective. This study shows pediatric donors yield sufficient stem cells for prompt engraftment and successful patient outcomes.
Area of Science:
- Hematology
- Transplantation Medicine
- Pediatric Stem Cell Transplantation
Background:
- Allogeneic peripheral blood progenitor cell (PBPC) transplantation is a recognized treatment modality.
- Previous reports have focused on adult donors for PBPC transplantation.
- The use of pediatric donors for allogeneic PBPC transplantation has not been extensively documented.
Purpose of the Study:
- To report the first series of allogeneic PBPC transplantation using related pediatric donors (ages 4-13 years).
- To evaluate the safety and efficacy of stem cell collection from pediatric donors.
- To assess the engraftment kinetics and clinical outcomes in recipients of pediatric PBPC grafts.
Main Methods:
- Five pediatric donors received 3-4 days of rhG-CSF for stem cell mobilization.
- PBPC collection was performed by continuous-flow apheresis.
- Apheresis procedures involved processing a median of 2.2 times the donor's total blood volume.
- Anticoagulation strategies were adapted for donors with low total blood volume.
Main Results:
- A median of 128 x 10(4) CD34+ cells/kg donor body weight were collected per procedure.
- One to two aphereses were sufficient to collect the target graft dose (3-4 x 10(6) CD34+ cells/kg recipient body weight).
- Engraftment of neutrophils and platelets occurred within 10-16 and 13-14 days, respectively.
- Two patients experienced acute GVHD (grades 1 and 3), and one experienced chronic GVHD.
- Two patients died from sepsis and VOD; however, three patients achieved remission from CML or hemophagocytic lymphohistiocytosis.
Conclusions:
- Allogeneic PBPC transplantation using pediatric donors is a safe procedure.
- Pediatric donors yield sufficient progenitor cells for prompt engraftment.
- Clinical outcomes in recipients of pediatric PBPC grafts are comparable to those receiving adult PBPC grafts.
Abstract:
Successful allogeneic peripheral blood progenitor cell (PBPC) transplantation has recently been reported by several transplant centers. This is a first report describing allogeneic PBPC transplantation in five patients using related pediatric donors between the ages of 4 and 13 years. Donors underwent 3 or 4 days of rhG-CSF treatment (6 micrograms/kg q 12 h) for stem cell peripheralization prior to PBPC collection, which was performed by continuous-flow apheresis on day 4 or 5. Venous access was exclusively by ante-cubital veins. A median of 2.2 times (range 1.4-3.6) the donor's total blood volume (TBV) was processed per procedure. In cases where the donor's TBV was < 2 liters, the blood cell separator was primed with human serum albumin (HSA-5%), and anticoagulation was performed using a combination of heparin (pre-apheresis bolus + continuous infusion (CI)) and/or ACD-A (CI at a reduced rate). The median number of CD34+ cells collected per kg of donor body weight (b.w.) and per liter of donor blood processed during each procedure was 128 x 10(4) (range 58 x 10(4)-314 x 10(4)). Between one and two aphereses were sufficient to collect a safe CD34+ cell engraftment dose of 3 or 4 x 10(6)/kg of recipient b.w. Two PBPC recipients were parents, and three were siblings. After freezing and thawing, the median number of CD34+ cells per kg of recipient b.w. thawed and transfused was 8.5 x 10(6) (range 3.2 x 10(6)-9.7 x 10(6)). The time to PMN > 1000/microliters was between 10 and 16 days (four out of five evaluable patients), and platelets > 20000/microliters were reached between day 13 and 14 post-transplantation (three out of five evaluable patients). Two out of three evaluable patients developed grades one and three acute GVHD, and one out of three developed chronic GVHD. Two patients died of sepsis and VOD at day 10 and 19, respectively. Two adult patients are alive and in cytogenetic and molecular remission of CML at +339 and +227 days post-allotransplantation. One 3-year-old girl with hemophagocytic lymphohistiocytosis is in remission at +304 days post-transplantation. Using pediatric donors for allogeneic PBPC transplantation appears to be safe, yields a sufficient amount of progenitors for prompt engraftment, and results in clinical outcome similar to adult PBPC allotransplantation.