Transplantation of peripheral blood progenitor cells from HLA-identical sibling donors

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Abstract

Summary

Transplantation of peripheral blood progenitor cells (PBPCs) has largely replaced autologous bone marrow transplantation. The same might occur in the allogeneic setting if the favourable initial experience with allogeneic PBPCT is confirmed. We analysed all primary transplants utilizing unmodified PBPC from HLA-identical sibling donors reported to the European Group for Blood and Marrow Transplantation (EBMT) for 1994. 59 patients with a median age of 39 years received myeloablative therapy for acute myelogenous leukaemia (23 patients), acute lymphoblastic leukaemia (13), chronic myelogenous leukaemia (nine), lymphoma (seven), or other diagnoses (seven) mostly of advanced stages followed by transplantation of allogeneic PBPC.

Three patients died soon after grafting, the others showed prompt haemopoietic recovery with median times to recover an absolute neutrophil count (ANC) above 0.5 and 1.0 X 109 /1 of 15 (range 9-27) and 17d (range 10-28) respectively. Time to platelet recovery above 20 or 50 X 109 /l was 16 (range 9-76) and 18d (range 12-100) respectively. 27 patients (46 percent) developed no or mild acute graft-versus-host disease (GVHD). The incidence of moderate (grade II) disease was 27 percent; 24 percent of the patients developed severe acute GVHD (grades III or IV). 55 percent of patients who were alive 90d after transplantation developed chronic GVHD, the probability to develop extensive chronic GVHD was 32 percent (95 percent confidence interval 22-42) with a median follow-up of 14 months. Overall and event-free survival (EFS) at 1 year were 54 percent (CI 48-60) and 50 percent (CI 43-57), respectively, the relapse incidence was 23 percent (CI 17-29). EFS was 67 percent (CI 55-79) in patients transplanted for acute leukaemias in first complete remission, chronic myelogenous leukaemia in first chronic phase, or sever aplastic anaemia.

Transplantation of allogeneic PBPC resulted in prompt and durable engraftment.The incidence and severity of acute and chronic GVHD seemed comparable to that observed after allogeneic BMT. Overall and event-free survival in this cohort of patients, most of whom suffered from advanced leukaemia or lymphoma, is encouraging, suggesting that the high numbers of T lymphocytes and/or natural killer cells contained in a typical PBPC collection product exert a vigorous graft-versus-leukaemia effect. Further evaluation of allogeneic PBPCT is highly desirable.

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