Journal of Clinical Oncology, Vol 14, 1314-1319, Copyright © 1996 by American Society of Clinical Oncology
Allogeneic blood cell transplantation without posttransplant colony- stimulating factors in patients with hematopoietic neoplasm: a phase II study
C Rosenfeld, R Collins, L Pineiro, E Agura and J Nemunaitis
Texas Oncology, Professional Association, Dallas, TX, USA.
PURPOSE: There is limited experience with allogeneic blood cell
transplantation (BCT). In an earlier pilot study, the combination of bone
marrow and blood did not produce severe acute graft-versus-host disease
(GVHD). We now report the results of a phase II study using blood stem
cells alone in 19 patients. PATIENTS AND METHODS: The median age was 40
years. All patients had hematopoietic malignancies and received transplants
from HLA-identical sibling donors. GVHD prophylaxis consisted of
cyclosporine plus prednisone. Posttransplant colony-stimulating factors
were not administered. Donors were mobilized with subcutaneous granulocyte
colony-stimulating factor (G-CSF; 16 microg/kg/d) for 5 days. Apheresis was
performed on 2 consecutive days. RESULTS: The median cell content of the
two apheresis was 11.9 x 10(8) WBC/kg, 3.2 x 10(8) CD3/kg, and 8.3 x 10(6)
CD34/kg. The median time to achieve an absolute neutrophil count (ANC) >
or = 500/microL was 13 days, and 14 days to a platelet count > or =
50,000/microL. All patients engrafted. Platelet recovery was faster in
marrow historic control groups. Blood cells in all tested cases contained
more than 95% donor cells on day 30. The actuarial incidence of acute GVHD
was 37%, and 13% for grade II-IV GVHD. Limited, corticosteroid responsive,
chronic GVHD developed in 33% of assessable patients. At a median follow-up
of 192 days, actuarial survival was 75%. CONCLUSION: Transplantation of a
high number of stem cells may lead to rapid engraftment without the use of
posttransplant colony-stimulating factors. GVHD does not appear to be more
severe than in similarly treated patients undergoing bone marrow
transplantation. For allogeneic transplantation, mobilized blood cell
collections are an alternative to bone marrow collections.
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