CD34+ cell dose effects on clinical outcomes after T‐cell replete haploidentical allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia using peripheral blood stem cells. A study from the acute leukemia working Party of the European Society for blood and marrow transplantation (EBMT)
- 17 April 2020
- journal article
- research article
- Published by Wiley in American Journal of Hematology
- Vol. 95 (8), 892-899
- https://doi.org/10.1002/ajh.25826
Abstract
Previous observations have reported controversial conclusions regarding cell dose and survival endpoints after allogeneic hematopoietic stem cell transplantation (HSCT). We conducted a retrospective analysis on 414 adult patients (median age 54 years, range, 18‐74) with acute myeloid leukemia (AML) in first and second complete remission who received a T‐cell replete allogeneic HSCT from haploidentical donors, using peripheral blood stem cells, between 2006‐2018. Median number of infused CD34+ was 6.58 x 106/kg (range, 2.2‐31.2). Graft‐versus‐host disease (GVHD) prophylaxis was post‐transplant cyclophosphamide in 293 patients and anti‐lymphocyte serum in 121 patients. Conditioning was myeloablative in 179 patients and reduced‐intensity in 235 patients. After a median follow‐up of 23.3 months (range, 12.1‐41.8), 2‐year overall survival (OS) was 64.5 % (95% CI 59.3‐69.7) with leukemia‐free survival (LFS) of 57.3 % (95% CI 51.8‐62.7) and non‐relapse mortality (NRM) of 23.3 % (95% CI 19‐27.7). Grades III‐IV acute GVHD day+100 incidence was 14.6 % while extensive chronic GVHD was 14.4% at 2‐years. Thirteen (3.2%) patients experienced graft failure. We found the optimal CD34+/kg threshold defining high (n= 334) versus low cell dose (n= 80) at 4.96 x 106. Recipients of > 4.96 x 106/kg CD34+ cells experienced less NRM (Hazard ratio [HR] 0.48; 95% CI 0.30‐0.76) and prolonged LFS (HR 0.63; 95% CI 0.43‐0.91) and OS (HR 0.60; 95% CI 0.40‐0.88) compared to those in the lower cell dose cohort. Larger cohort studies are needed to confirm these findings.Keywords
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