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Transplantation of allogeneic CD34+ blood cells
H Link, L Arseniev, O Bahre, JG Kadar, H Diedrich and H Poliwoda
Department of Hematology and Oncology, Medizinische Hochschule Hannover,
Germany.
Pluripotent stem cells of hematopoiesis and lymphopoiesis are among the
CD34+ cells in blood or bone marrow. After granulocyte-colony stimulating
factor (G-CSF) treatment, 1% to 2% of the mononuclear cells in blood are
CD34+ cells, which can be procured by leukapheresis. We investigated the
potential of CD34+ blood cells for reconstituting hematopoiesis and
lymphopoiesis after allogeneic transplantation. HLA- identical sibling
donors of 10 patients with hematologic malignancies were treated with G-CSF
(filgrastim), 5 microgram/kg subcutaneously twice daily for 5 to 7 days.
CD34+ cells were selected from the apheresis concentrates by
immunoadsorption, concomitantly the number of T cells was reduced 100- to
1,000-fold. After transplantation, five patients received cyclosporine A
for graft-versus-host disease (GvHD) prophylaxis (group I); five patients
additionally received methotrexate (group II). G-CSF and erythropoietin
were given to all patients. Mean numbers of 7.45 x 10(6) CD34+ and 1.2 x
10(6) CD3+ cells per kilogram were transplanted. In group I, the median
times of neutrophil recovery to 100, 500, and 1,000 per mm3 were 10, 10,
and 11 days, respectively. Group II patients reached these neutrophil
levels after 10, 14, and 15 days, respectively. Platelet transfusions were
administered for a median of 18 days in group I and 30 days in group II,
and red blood cells for 9 and 12 days, respectively. Between day 30 and 60,
lymphocytes reached levels of 353 +/- 269 cells per mm3. The median grades
of acute GvHD were III in group I and I in group II. Two patients in group
I died from acute GvHD. Two leukemic relapses occurred in group II.
Complete and stable donor hematopoiesis was shown in all patients with a
median follow up of 370 (45 to 481) days. Allogeneic blood CD34+ cells can
successfully reconstitute hematopoiesis and lymphopoiesis. Reduction of T
cells by CD34+ blood cell enrichment and cyclosporine A alone might not be
sufficient for prophylaxis of severe acute GvHD.
Volume 87,
Issue 11,
pp. 4903-4909,
06/01/1996
Copyright © 1996 by The American Society of Hematology
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