Lack of benefit of CD34+ cell selected over non-selected peripheral blood stem cell transplantation in multiple myeloma: results of a single center study

Abstract

In order to determine the clinical impact of CD34؉ cell selected autologous transplantation in multiple myeloma (MM), we have performed a retrospective case-controlled analysis comparing 21 MM patients receiving high-dose melphalan and autologous transplantation with CD34؉ peripheral blood stem cells (PBSC) as front-line therapy to 21 control patients receiving unselected products. Case matching was performed using the following criteria: age and ␤2-microglobulin at diagnosis and disease status at the time of transplantation. Both cohorts were homogeneous in term of induction treatment and conditioning regimen. Patients were collected for CD34؉ selection after priming with G-CSF alone. Significantly fewer CD34؉ cells/kg were infused to patients in the selected group as compared to patients in the control group: 2.2 (range 0.5-14.3) vs 9.4 (range 1.1-15) (P Ͻ 0.001). The median time to neutrophil recovery у0.05 ؋ 10 9 /l was 10 days for the CD34 ؉ group and 9.5 days for the control group (P ‫؍‬ 0.357). The median time to platelet recovery у 20 ؋ 10 9 /l was 9 days for the CD34 ؉ group and 4.5 days for the control group (P ‫؍‬ 0.005). Response rates were comparable in both groups (85.7% in the CD34 ؉ group vs 90.4% in the control group). At 3 years, event-free survival (32% in the CD34 ؉ group vs 39% in the control group) and overall survival (85% in the CD34 ؉ group vs 79% in the control group) were not significantly different. Finally, use of unselected products dramatically reduced the cost of the transplantation procedure. This study shows that CD34؉ cell selected autologous transplantation is more expensive than transplantation with unselected products and does not improve the clinical outcome of patients with MM. Leukemia (2000) 14, 1815-1820.

Re‐infused lymphocyte dose does not influence disease control following upfront autologous stem cell transplantation for multiple myeloma

“…with the lowest LY-DO secondary to patient-independent, ex-vivo modification of the graft) had similar outcome to the patients receiving unselected grafts. The inclusion of the CD34-selected group is validated by reports that CD34-selection does not impact PFS or OS (Vescio et al, 1999;Morineau et al, 2000;Bourhis et al, 2007). Our series differed significantly from that reported by Porrata et al (2004) in the much lower LY-DO infused.…”

Guidelines on the diagnosis and management of multiple myeloma 2005

“…Purging harvested stem cells with monoclonal antibodies and/ or CD34 + stem cell selection does reduce contamination with tumour cells. However, no reduction in relapse risk has been observed (Morineau et al, 2000;Stewart et al, 2001) while the risk of viral infection post-transplant may be increased following CD34 selection (De Rosa et al, 2004;Bourhis, 2005).…”

Current status of stem cell transplantation for multiple myeloma

“…Patients achieving a complete response are most likely to benefit from high-dose therapy [17]. Purging of the stem cell apheresis product appears to have no value in prolonging the response [19], suggesting that relapse is derived from a resistant compartment of cells that persists after high-dose therapy [20]. (Table 2) was pioneered at the University of Arkansas, (Little Rock, AR).…”