Bone marrow haploidentical transplant with post-transplantation cyclophosphamide: does graft cell content have an impact on main clinical outcomes?
We analyzed data relative to cell content in 88 consecutive patients receiving HLA haploidentical bone marrow (BM) transplants with post-transplantation cyclophosphamide (PT-CY). Median age was 54.5 (range, 17-72); diagnoses were acute leukemia (n = 46), lymphoproliferative disorders (n = 24), myelofibrosis (n = 11) and myelodysplastic syndromes (n = 5). Total nucleated cell (TNC) and CD34+, CD3+, CD4+ and CD8+ cell doses were stratified as higher than first, second and third quartile and the dose effect on various clinical outcomes was assessed. Median time to engraftment was 17 days for neutrophils and 24 days for platelets. To receive a dose of TNC ≥3.2 x 106/kg or CD34+ cells ≥2.7 x 106/kg significantly shortened the time to neutrophil and platelet engraftment and reduced the blood product requirements in the 30-day period after transplantation. Overall, TNC and CD34+ cell doses had no effect on acute graft-versus-host disease (GVHD) incidence, whereas patients receiving higher CD3+ and CD8+ cell doses seemed to have less chronic GVHD. No effect on non-relapse mortality, progression-free survival and overall survival was observed at different cell dose thresholds. These data suggest that in HLA haploidentical BM transplant with PT-CY, appropriate cell doses are relevant to the engraftment. The association between low CD3+/CD8+ cells and chronic GVHD deserves further investigation.
['Teofili|Luciana|L|', 'Chiusolo|Patrizia|P|', 'Valentini|Caterina Giovanna|CG|', 'Metafuni|Elisabetta|E|', 'Bellesi|Silvia|S|', 'Orlando|Nicoletta|N|', 'Bianchi|Maria|M|', 'Giammarco|Sabrina|S|', 'Sica|Simona|S|', 'Bacigalupo|Andrea|A|']
D000293:Adolescent D000328:Adult D000368:Aged D016026:Bone Marrow Transplantation D002648:Child D002675:Child, Preschool D046528:Chimerism D003520:Cyclophosphamide D018572:Disease-Free Survival D005260:Female D006086:Graft vs Host Disease D006801:Humans D015470:Leukemia, Myeloid, Acute D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D009364:Neoplasm Recurrence, Local D009504:Neutrophils D017713:Platelet Transfusion D016016:Proportional Hazards Models D014019:Tissue Donors D000075442:Transplantation, Haploidentical D016896:Treatment Outcome D055815:Young Adult
bone marrow haploidentical transplant cyclophosphamide engraftment graft-versus-host disease