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Poor graft function can be durably and safely improved by CD34+-selected stem cell boosts after allogeneic unrelated matched or mismatched hematopoietic cell transplantation

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Insufficient production of leukocytes, thrombocytes and erythrocytes after allogeneic peripheral blood stem cell transplantation (PBSCT) represents a life-threatening complication.

Methods

In 20 adult patients with poor graft function (PGF defined as transfusion-dependent platelet counts <20,000/µl, or leukocytes <1500/µl, or transfusion-dependent anemia) and variable causes of PGF after allogeneic PBSCT, immunomagnetically selected CD34+ stem cell boosts (SCB) from matched unrelated (n = 8), mismatched unrelated (n = 11) or haploidentical (n = 1) donors were applied without prior conditioning.

Results

Patients received a median of 4.6 × 106 CD34+ cells per kilogram bodyweight (1.9–9.1 × 106) and low T cell numbers (median 0.2 × 104, range 0.04–0.6 × 104). All patients showed responses in at least one hematopoietic lineage. Engraftment for platelets, leukocytes and hemoglobin was 88, 88 and 100 % after a median of 14, 13 and 18 days, respectively. With regard to the complete cohort, 90 % (n = 18) showed an increase in platelets (median 76,500/µl, range −7000 to 223,000/µl), 95 % (n = 19) had an increase in leukocytes (median 3110/µl, range 150–13,740/µl) and 90 % (n = 18) improved with regard to hemoglobin (median 1.9 g/dl, range −0.9 to 5.1 g/dl). Due to effective T cell depletion, only one patient developed graft versus host disease (GvHD, grade III) after SCB. Patients were followed for a median of 7.5 months (1–74 months) with 11 patients being alive and disease free with normalized peripheral blood counts at the end of follow-up.

Conclusions

CD34+-selected SCB are safe and effective and can durably improve PGF even in patients receiving grafts from unrelated matched or mismatched donors with low incidence of GvHD.

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Acknowledgments

The authors wish to thank the team of the stem cell laboratory Tübingen, especially Stefanie Ackermann and Gabriele Hochwelker, as well as Dr. Barbara Schmid-Horch of the Department for Transfusion Medicine Tübingen for provision of serology results.

Funding

Sebastian P. Haen was supported by the Deutsche José Carreras Leukemia Foundation (Grant No. DJS 08-04).

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Authors and Affiliations

  1. Abteilung II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany

    Sebastian P. Haen, Christoph Faul, Lothar Kanz, Wolfgang A. Bethge & Wichard Vogel

  2. Abteilung Immunologie, Interfakultäres Institut für Zellbiologie, Auf der Morgenstelle 15, 72076, Tübingen, Germany

    Sebastian P. Haen

  3. Klinik für Kinder- und Jugendmedizin, Hoppe Seyler Str. 1, 72076, Tübingen, Germany

    Michael Schumm

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  1. Sebastian P. Haen
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Correspondence to Sebastian P. Haen.

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All authors declare that they have no conflict of interest to disclose.

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This article presents data of retrospective analyses and does not contain data of any clinical study.

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Haen, S.P., Schumm, M., Faul, C. et al. Poor graft function can be durably and safely improved by CD34+-selected stem cell boosts after allogeneic unrelated matched or mismatched hematopoietic cell transplantation. J Cancer Res Clin Oncol 141, 2241–2251 (2015). https://doi.org/10.1007/s00432-015-2027-x

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