Impact of donor-derived CD34 + infused cell dose on outcomes of patients undergoing allo-HCT following reduced intensity regimen for myelofibrosis: a study from the Chronic Malignancies Working Party of the EBMT.
Tomasz CzerwSimona IacobelliVittoria MalpassutiLinda KosterNicolaus M KrögerMarie RobinJohan MaertensPatrice ChevallierEmma WatzXavier PoireJohn A SnowdenJürgen H E KuballFrancesca A M KinsellaDidier BlaisePéter ReményiJean-Baptiste MearJörg CammengaMarie Thérèse RubioSebastien MauryEtienne DaguindauDamian FinneganPatrick J HaydenJuan Carlos Carlos Hernández-BoludaDonal P McLornanIbrahim Yakoub AghaPublished in: Bone marrow transplantation (2021)
The optimal CD34 + cell dose in the setting of RIC allo-HCT for myelofibrosis (MF) remains unknown. We retrospectively analyzed 657 patients with primary or secondary MF transplanted with use of peripheral blood (PB) stem cells after fludarabine/melphalan or fludarabine/busulfan RIC regimen. Median patient age was 58 (range, 22-76) years. Donors were HLA-identical sibling (MSD) or unrelated (UD). Median follow-up was 46 (2-194) months. Patients transplanted with higher doses of CD34 + cells (>7.0 × 106/kg), had an increased chance of achievement of both neutrophil (hazard ratio (HR), 1.46; P < 0.001) and platelet engraftment (HR, 1.43; P < 0.001). In a model with interaction, for patients transplanted from a MSD, higher CD34 + dose was associated with improved overall survival (HR, 0.63; P = 0.04) and relapse-free survival (HR, 0.61; P = 0.02), lower risk of non-relapse mortality (HR, 0.57; P = 0.04) and higher rate of platelet engraftment. The combined effect of higher cell dose and UD was apparent only for higher neutrophil and platelet recovery rate. We did not document any detrimental effect of high CD34 + dose on transplant outcomes. More bulky splenomegaly was an adverse factor for survival, engraftment and NRM. Our analysis suggests a potential benefit for MF patients undergoing RIC PB-allo-HCT receiving more than 7.0 × 106/kg CD34 + cells.
Keyphrases
- free survival
- cell cycle arrest
- patients undergoing
- stem cells
- end stage renal disease
- cell therapy
- induced apoptosis
- nk cells
- peripheral blood
- single cell
- ejection fraction
- chronic kidney disease
- newly diagnosed
- heavy metals
- type diabetes
- metabolic syndrome
- cell death
- peritoneal dialysis
- case report
- emergency department
- magnetic resonance
- high dose
- oxidative stress
- cardiovascular disease
- risk factors
- patient reported outcomes
- cardiovascular events
- hematopoietic stem cell
- data analysis