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Rapid engraftment after allogeneic transplantation using CD34-enriched marrow cells
K Cornetta1, V Gharpure, B Mills
1Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202, USA.
Bone Marrow Transplantation
|March 5, 1998
Summary
CD34 selection in allogeneic bone marrow transplantation (BMT) effectively enriches for progenitor cells, enabling rapid engraftment. This method significantly reduces T lymphocytes, preventing severe graft-versus-host disease (GVHD) without compromising patient safety.
Area of Science:
- Hematology
- Immunology
- Transplantation Medicine
Background:
- Bone marrow cells expressing CD34 are enriched for hematopoietic progenitor cells crucial for long-term engraftment.
- CD34 selection in allogeneic bone marrow transplantation (alloBMT) aims to reduce T lymphocytes and prevent graft-versus-host disease (GVHD).
Purpose of the Study:
- To evaluate the efficacy and safety of CD34-selected marrow in HLA-identical sibling alloBMT.
- To assess engraftment kinetics, GVHD incidence, and survival rates following CD34-enriched alloBMT.
Main Methods:
- Utilized the Isolex 300 SA device for CD34 cell selection in 14 patients undergoing HLA-identical sibling alloBMT.
- Patients received a conditioning regimen including TBI, thiotepa, cyclophosphamide, ATG, and methylprednisolone, followed by CD34-enriched marrow infusion.
- Post-transplant immunosuppression was limited to a 5-week course of steroids.
Main Results:
- Infused marrow achieved 64.9% CD34 purity with a 2.7-log depletion of CD3 T cells.
- Median times to sustained granulocyte (>500) and platelet (>20,000) engraftment were 10.5 and 27 days, respectively.
- No graft rejections, grade III/IV GVHD, or unexpected toxicities were observed; 100-day survival was 86%.
Conclusions:
- CD34 selection is a safe and effective strategy for allogeneic BMT, facilitating rapid engraftment.
- This approach significantly reduces T cell contamination, mitigating the risk of severe GVHD.
- CD34-enriched alloBMT offers a promising therapeutic option with favorable early outcomes.