Faster neutrophil and platelet engraftment, but no differences in acute GVHD or survival, using peripheral blood stem cells from related and unrelated donors, compared to bone marrow

Summary:Human herpesvirus 6 (HHV-6) infection and the HHV-6-specific lymphocyte proliferation response were studied longitudinally in 24 patients in the first 3 months after allogeneic stem cell transplantation (allo-SCT). HHV-6 DNAemia was analyzed by a nested PCR method, and the HHV-6-specific lymphocyte proliferation responses were evaluated with a standard lymphocyte proliferation assay. All patients who responded to HHV-6 GS (variant A) antigen also responded to HHV-6 Z29 (variant B) antigen, and a response to HHV-6 Z29 antigen was detected more often than to HHV-6 GS antigen after allo-SCT (P = 0.048). HHV-6 DNA was detected in more patients after than before transplantation (P = 0.01) and in more patients with acute GVHD grades II-IV than those without (P = 0.009). An HHV-6-specific proliferative response was more often detected in patients without, than in those with persistent HHV-6 infection (three consecutively positive PBL samples; P Ͻ 0.001). Patients with persistent HHV-6 infection had lower lymphocyte counts from the 8th week after transplantation than those without (P = 0.03). No HHV-6-specific proliferation responses were detected in the three patients who developed HHV-6 disease. HHV-6 infection was associated with persistent lymphocytopenia and might thereby inhibit immune function.

Section: Discussionsupporting

confidence: 61%

Human herpesvirus 6 infection inhibits specific lymphocyte proliferation responses and is related to lymphocytopenia after allogeneic stem cell transplantation

Wang

Linde

Dahl

et al. 1999

“…17 Engraftment was assessed according to published criteria. 7 Briefly, myeloid engraftment was defined as the first of 3 consecutive days when the absolute neutrophil count was higher than 0.5 × 10 9 /l.…”

Section: Evaluation and Definitionmentioning

confidence: 99%

Feasibility and safety of peripheral blood stem cell transplantation from unrelated donors: results of a single-center study

Blau

Basara

Lentini

et al. 2001

Summary:We compared the outcomes in patients receiving unrelated peripheral blood stem cell transplants (PBSCT) with those receiving bone marrow transplants (BMT) in a matched pair analysis. Seventy-four patients with hematological malignancies with HLA-matched (77%) and mismatched (23%) donors were analyzed in this study. Thirty-four patients (45%) were considered as high risk patients. Sixty-eight patients received standard conditioning regimens with Bu/Cy or TBI/Cy. Six patients received an intensified conditioning regimen with the addition of etoposide, thiotepa or melphalan. GVHD prophylaxis consisted of prednisolone, cyclosporine and methotrexate. Groups were matched for patient, donor, transplant characteristics and HLA compatibility. Peripheral blood stem cell collection led to the collection of a higher number of CD34 + and CD3 + cells in comparison to bone marrow collection. Leukocyte engraftment in the PBSCT group occurred in 14 days (median; range 6-26 days) and in the BMT group in 19 days (range 9-29 days; P Ͻ 0.02). The time of platelet engraftment did not differ significantly. The incidence of grades II-lV acute GVHD in the group of HLA-identical patients was 35% in the PBSCT group and 25% in the BMT group (P Ͻ 0.33, log-rank). However, there was a significant difference (P Ͻ 0.05, logrank) in incidence and time to onset of acute GVHD II-IV comparing all patients, including the 17 mismatched transplants. Disease-free survival was 51% (19 patients) with a median of 352 days and 59% (21 patients) with a median of 760 days for PBSC and BMT transplants, respectively. In conclusion, our results indicate that allogeneic PBSCT led to significantly faster leukocyte engraftment but is associated with a higher incidence and more rapid onset of severe acute GVHD comparing all patients, including the 17 mismatched transplants. However, the incidence of severe acute GVHD in HLAidentical patients was not different between the PBSCT and BMT groups. Bone Marrow Transplantation (2001) 27, 27-33.

“…Whether the incidence of cGVHD increased in patients undergoing alloPBSCT is still controversial. [8][9][10][11][12][13][14][15][16][17] There appears to be a trend towards a higher incidence of cGVHD. 18 Our previous retrospective comparative study (containing standard as well as high risk patients) showed an increased cGVHD compared to bone marrow (24.1% vs 78.1%).…”

Section: Discussionmentioning

confidence: 99%

“…While faster neutrophil and platelet engraftment with shorter duration of hospitalization and lower antibiotic use have been seen compared to BMT, 8,9 whether or not GVHD is more common and the relapse rate is different, is not yet clear. [8][9][10][11][12][13][14][15][16][17] In this report, we summarize our experience with alloPBSCT in standard risk leukemia: AML in first complete remission (CR), or CML in early first chronic phase.…”

mentioning

confidence: 99%

Allogeneic peripheral blood stem cell transplantation for standard risk leukemia: experience of İbni Sina Hospital

Arslan

Çoşkun

Arat

et al. 2000

Summary:Fifty-three patients with standard risk leukemia who underwent allogeneic peripheral blood stem cell transplantation (alloPBSCT) from their HLA-identical siblings were analyzed for engraftment, incidence and severity of GVHD, and relapse rate. Standard risk leukemia was defined as AML in first complete remission or CML in first chronic phase within the first year after diagnosis. The median age was 34.5 years (range 13-47). Stem cells were mobilized by using 10 g/kg G-CSF subcutaneously for 5 days. A median of 5.7 (2.1-21.4) × 10 6 /kg CD34 + cells was collected over a median of 2 (range 1-5) apheresis procedures. Cyclosporin A (CsA) plus short-course MTX were used for GVHD prophylaxis. Recovery to granulocytes Ͼ0.5 × 10 9 /l and platelets Ͼ20 × 10 9 /l occurred at a median of day +13 (range 8-32) and +13 (range 8-51), respectively. Day +100 transplant-related mortality was 13.2% (7/53). Acute GVHD occurred in 20 of 49 (41%) evaluable patients and only six (12.3%) of them had severe disease (grade III-IV). Chronic GVHD occurred in 30 of 42 (71.4%) evaluable patients. Relapse rate at 2 years was 7.5%. The median overall and leukemia-free survivals were 22 (4-44) and 20 (3-44) months, respectively. Estimated 4 year leukemia-free and overall survival rates were 60% and 62%, respectively. In conclusion, alloPBSCT in standard risk leukemia seems to be associated with a low relapse rate and no increased risk of acute GVHD, but there is a trend for higher incidence of cGVHD. Bone Marrow Transplantation (2000) 25, 1229-1232.