Overcoming various comorbidities by G-CSF-primed unmanipulated BM SCT in adult patients with AML

Abstract

We examined whether the use of G-CSF-primed unmanipulated bone marrow (pBM) permits successful transplantation in patients with adverse comorbid pretransplantation conditions. A total of 33 patients at variable risk of AML undergoing allogeneic SCT from an HLA-identical sibling participated. The patients suffered from a variety of treatment-related sequelae before SCT and many cases also featured the presence of major organ dysfunction. The median follow-up duration of patients who were among the overall survivors was 58 months (range, 11À125 months). The median number of CD34 þ cells infused was 3.5 Â 10 6 per kg (range, 0.8À15.6 Â 10 6 per kg). The median number of days for recovery of ANC and platelet count without transfusion was 13 (range, 6À22) and 18 (range, 11À29) days, respectively. Four patients (12%) died due to nonrelapse causes and only one patient developed the same course of infectious complication as before SCT. No particular finding in the context of CMV infection or other post transplant complication was observed. The estimated 10-year overall survival rate was 68%. Our results suggest that the use of pBM allows successful engraftment without increasing complications in patients with various comorbidities before transplantation.

Use of G-CSF-stimulated marrow in allogeneic hematopoietic stem cell transplantation settings: a comprehensive review

“…Reassuring disease‐free survival (DFS) results (45% to 60 ± 7%) seem to indicate that the graft‐versus‐leukemia effect is present despite the low T‐cell dose compared with those of G‐PBCST; however, this result should be confirmed by longer follow‐up. Together with the results of other researchers (8–10, 14–16, 18, 20–22, 28), these data suggest that the use of G‐CSF‐stimulated marrow transplantation appears safe and feasible both in HLA‐matched siblings and in haploidentical transplant settings.…”

“…A randomized comparative study exploring the differences in outcomes of G‐BM transplant (G‐BMT) vs. G‐CSF‐mobilized PBSC transplant (G‐PBSCT) has been performed in Australia (20). The most recent reports concerning G‐BMT are from Vanderbilt University (9), the Catholic University of Korea (18), and Children’s Healthcare of Atlanta (6). Several other authors in the United States (10, 16), Canada (28), and China (44) have published retrospective studies highlighting the differences in G‐BMT vs. G‐PBCST or SS‐BMT.…”

“…Other researchers focused on G‐BMT in patients with adverse comorbid pre‐transplantation conditions (18). At the Catholic University of Korea, Kim et al.…”

“…At the Catholic University of Korea, Kim et al. (18) used G‐BM as stem cell source after myeloablative (n = 28) or non‐myeloablative (n = 5) conditioning. All patients showed successful engraftment.…”

“…However, the use of PBSCs has been associated with a higher risk of chronic graft‐versus‐host disease (GVHD), which may adversely affect quality of life as well as survival (2, 4, 5). Some researchers have evaluated the use of allogeneic bone marrow transplants obtained from G‐CSF‐stimulated healthy donors (6–30); these studies established the safety of using this cellular source and the ability of G‐CSF‐stimulated bone marrow grafts (G‐BM) to produce rapid and sustained engraftment. A growing body of clinical evidence suggests that stimulated bone marrow transplants may share the advantages of blood stem cell transplants without increased risk of chronic GVHD, which is associated with blood stem cell transplants (9, 12, 14, 17, 18, 20, 22).…”