CD34 Augmentation Improves Allogeneic T Cell-Depleted Bone Marrow Engraftment
1998; Mary Ann Liebert, Inc.; Volume: 7; Issue: 2 Linguagem: Inglês
10.1089/scd.1.1998.7.151
ISSN2168-6556
AutoresStephen J. Noga, Adriana Seber, Janice M. Davis, R. J. Berenson, G. B. Vogelsang, H. Braine, Allan D. Hess, Deborah Marcellus, Carl Miller, Saul J. Sharkis, Steven N. Goodman, George W. Santos, Richard J. Jones,
Tópico(s)Immunotherapy and Immune Responses
ResumoT cell depletion (TCD) performed by elutriation has decreased the incidence of acute and chronic graft-versus-host disease (GvHD) following bone marrow transplantation (BMT). However, as with all forms of TCD, patients may experience graft failure (10%), delayed engraftment, and mixed chimerism. Because 66%-75% of the CD34+ cells coseparate with the small lymphocytes, which are removed by elutriation, we designed a phase I trial in HLA-identical siblings to determine if the readdition of these previously lost small CD34+ cells would improve elutriation's engraftment kinetics. CD34+ cells were isolated from the small cell fraction of 10 consecutive donor grafts and infused into the recipients along with the TCD graft. The positively selected product had a mean T cell content of 1.2 x 10(5)/kg and was 80% CD34+, doubling the CD34+ content of the graft. All patients engrafted promptly with a median time to 500 neutrophils/mm3, untransfused 50,000 platelets/mm3, and discharge from the hospital of 19 (range 10-25), 24 (14-52), and 24 (18-29) days, respectively. Acute GvHD occurred in 2 patients, and no patient had chronic GvHD. Augmenting stem cell dose may be an efficient and safe alternative for overcoming TCD-associated delayed engraftment and graft failure, rather than increasing immunosuppression.
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