Clinical significance of CD34+ cell dose in long-term engraftment following autologous peripheral blood stem cell transplantation

Abstract

Summary:The number of CD34 ؉ cells has been described as the best parameter for predicting the quality of engraftment in peripheral blood progenitor cell (PBPC) transplantation in the early post-transplant period. In this study we have determined the optimal number of CD34 ؉ cells in order to maintain engraftment in the long term in a series of 100 patients receiving autologous PBPC transplantation. Based on our previous experience on the speed of early hematopoietic recovery, four subgroups of patients were established: patients infused less than 0.75 ؋ 10 6 /kg CD34 ؉ (n = 9), 0.75 to 1.25 (n = 24), 1.25 to 2.0 (n = 37) and more than 2.0 (n = 30). These groups were designated as low, intermediate-low, intermediate-high and high CD34 groups, respectively. Transitory loss of neutrophil engraftment was observed in 67%, 30%, 16% and 6% of patients in the four mentioned CD34 groups respectively, with statistically significant differences between the different groups. Significant differences were also observed between the low CD34 group and the rest of the groups as regards platelet and red blood cell transfusion requirements, fever episodes, days of hospitalization and antibiotic requirements throughout the first year. Our results show that the dose of CD34 ؉ cells influences engraftment also in the late post-transplant period, and correlates with transfusion and antibiotic requirements, fever episodes and days of hospitalization during the first year posttransplant.

Effect of cumulative etoposide doses on the outcome of autologous peripheral-blood progenitor-cell transplantation for lymphoma

“…In our study, in accordance with previous reports, [8][9][10]31 we found that the CD34 þ cell dose infused directly influenced the speed of neutrophil and platelet engraftment. In addition, it was the single factor affecting long-term engraftment.…”

“…It should be pointed out that we have used a very sensitive and specific method in which 300 000 events were screened. The reproducibility of this method, and its ability to predict the speed of hematopoietic recovery, 8,9 indicates that this is a reliable method for the assessment of progenitor-cells.…”

“…4 Prior chemotherapy, number of CD34 þ cells infused, and administration of hematopoietic growth factors influence hematologic recovery. [5][6][7][8][9][10][11][12] Several studies using animal models have shown that cytotoxic agents such as busulfan, BCNU, melphalan, or platinum derivates reduce the repopulating capacity of BM, whereas others have not demonstrated such an association. [13][14][15][16] Clinical trials evaluating the impact of previous chemotherapy on progenitor-cell yield and engraftment have shown conflicting results.…”

Predictive factors for hematopoietic engraftment after autologous peripheral blood stem cell transplantation for AL amyloidosis

“…Although some studies have shown a reduction in RBC transfusion requirements with higher stem cell doses, 20,21 we did not find this to be the case in our patient population. The lack of an association between stem cell dose and RBC transfusions may be due to a relatively higher incidence of grades 3-4 hemorrhagic complications in our study group (13.8%).…”

Characterization of hemopoietic engraftment kinetics and development of secondary cytopenia in AML post auto-SCT and its correlation with survival outcome

“…The rapid recovery of neutrophils and plts after AHSCT has been extensively studied and many reports have associated this with the total number of CD34 þ hemopoietic progenitor cells present in the infused autograft. [17][18][19]33 All our patients met the minimum recommended stem cell dose of 2.5 Â 10 6 CD34/kg, and this likely explains the early neutrophil and plt engraftment observed.…”