Tandem autologous stem cell transplantation (ASCT) improves long-term survival of platinum-refractory germ cell tumors (GCT) patients. Studies, predominantly in lymphoma, showed that CD34 cell doses > 5.0 × 10/kg/single transplant led to decreased resource utilization. Because most GCT patients have received prior cisplatin-based treatment, collecting >10 × 10 CD34 cells/kg is challenging. We analyzed the effect of CD34 cell dose on resource utilization and outcome in 131 GCT patients, median age 29.5 years (range, 16 to 58), undergoing tandem ASCT. Of 262 individual transplants performed, 120 were performed as inpatient and 142 as planned outpatient. Overall, median CD34 dose per transplant was 3.1 × 10/kg (range, 0.8 to 16.0), with no significant difference between inpatient and outpatient transplants. Patients were divided into quartiles based on the CD34 cell dose infused: Q1, 0.8 to 1.9 × 10/kg; Q2, 2.0 to 2.9 × 10/kg; Q3, 3.0 to 4.1 × 10/kg; and Q4, 4.2 to 16.0 × 10/kg. For all patients higher CD34 cell doses were associated with significantly shorter times to neutrophil (P <.001) and platelet recovery (P <.001). For inpatient transplants higher CD34 doses were significantly associated with shorter length of hospital stay (P <.001), fewer days of filgrastim (P <.001), i.v. antibiotic (P = .012) and antifungal (P = .03) usage; and fewer RBC (P = .001) and platelet units transfused (P <.001), resulting in overall lower cost of care (P< .001). Of the 142 planned outpatient transplants, 100 admissions were required for a median length of hospital stay of 7.0 days (range, 1 to 18). Although there was no significant difference in the rates of hospitalization between patients in different CD34 cell dose quartiles, a significant trend was observed for shorter hospitalization (P = .01) and fewer RBC (P = .002) and platelet (P = .005) transfusions with higher CD34 cell dose quartile. Patients receiving CD34 cell doses in the lowest dose quartile (Q1) had significantly worse progression-free survival and overall survival compared with patients receiving higher CD34 cell doses. Overall, resource utilization, including cost of care, is significantly reduced when patients receive higher CD34 cell doses, indicating greater efforts to improve peripheral blood stem cell collection in this population are needed.

disease (GvHD) prophylaxis regimen. Survival analysis was calculated by Kaplan-Meier analysis and log-rank test was used to compare variables. Forty-three patients (21 of male) were enrolled; 22, 19 and 2 patients were diagnosed as ALL, AML and MDS, respectively. Twenty-three patients received TBI-regimen, and 26 patients received mother derived stem cell products. Most of the donors had 5/10 or 6/10 HLA-matched. The median CD34+ cell dose was 9.24 (2.06-21.8) cells £10 6 /kg. One patient died from disseminated adenoviral infection prior to neutrophil engraftment. For 42 evaluable patients, the median time to neutrophil and platelet engraftment was 15 (12-26) days and 22 (12-100) days, respectively. At the median follow-up time of 18.5 (0.6-74.2) months, the overall survival rates of TBI-regimen and Thio-regimen were 63.68 and 61.98%, respectively (p=0.69), while the event-free survival rates of TBI-regimen and Thio-regimen were 68.82 and 66.67%, respectively (p=0.61). Viral infections, CMV, BKV and adenovirus, were the most common infectious complications and were comparable in both groups. Moreover, rates of acute and chronic GVHD in both groups were not significantly different. Relapse was the most common cause of death in both regimens while non-relapse mortality rates of both regimens were approximately 17%. Haplo-identical SCT in high-risk pediatric hematologic malignancies using Thio-regimen had comparable clinical outcomes and complications as those using TBI-regimen.

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Conclusions: GvHD prophylaxis with Pt-Cy/Ben/csa decreased by 3-times 1y-NRM, proved superior to Pt-Cy/sirolimus in engraftment and NK cell 30-day recovery. Although the historical cohort comparison is not absent of various biases, the association was robust after adjusting for many potential confounders. We consider that this novel strategy deserves further research in larger and better-designed studies.

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