Transplantation of highly purified CD34+ progenitor cells from unrelated donors in pediatric leukemia

被引:83
作者
Lang, P
Handgretinger, R
Niethammer, D
Schlegel, PG
Schumm, M
Greil, J
Bader, P
Engel, C
Scheel-Walter, H
Eyrich, M
Klingebiel, T
机构
[1] Univ Tubingen, Childrens Hosp, D-72074 Tubingen, Germany
[2] Univ Tubingen, Inst Biostat, D-72074 Tubingen, Germany
[3] Univ Wurzburg, Childrens Hosp, D-97070 Wurzburg, Germany
[4] Goethe Univ Frankfurt, Childrens Hosp, D-6000 Frankfurt, Germany
关键词
D O I
10.1182/blood-2002-04-1203
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Unrelated donors are commonly used for hematopoietic stem cell transplants, but graft-versus-host disease (GVHD) is a major problem. We investigated whether transplantation of purified mobilized peripheral-blood CD34(+) stem cells from unrelated donors would prevent acute and chronic GVHD in pediatric patients with leukemia and avert the need for pharmacologic immunosuppression. Thirty-one pediatric patients with acute lymphoblastic leukemia (ALL, n = 16), acute myeloid (n = 7), chronic myeloid (n = 6), or juvenile myelomonocytic leukemia (n = 2) underwent transplantation. The median purity of CD34(+) cells after positive magnet-activated cell sorting was 98.5%. ,Patients received a median of 8.0 X 106 CD34(+) cells and 6 x 10(3) CD3(+) T lymphocytes per kilogram, with no posttransplantation pharmacologic immunosuppression. Primary acute GVHD : grade II was seen in only 10% of patients (n = 3) and occurred only after human herpesvirus 6 (HHV 6) infection. Two patients had limited chronic GVHD. Engraftment occurred in all patients (primary engraftment, n 26; engraftment after reconditioning, n = 5). The 2-year survival estimate was 38% for all patients and 63% for patients with ALL in complete remission. Patients with myeloid malignancies had a poor outcome. In comparison to a historical control group who received unmanipulated bone marrow, our patients had a lower incidence of GVHD (P < .001). No difference was observed in the probability of relapse or survival. Study patients with ALL in remission showed a trend toward better survival (P = .07). Transplantation of purified peripheral-blood CD34(+) cells from unrelated donors effectively minimizes GVHD and may be a good therapeutic option for patients with relapsed ALL. (C) 2003 by The American Society of Hematology.
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收藏
页码:1630 / 1636
页数:7
相关论文
共 56 条
[1]  
APPERLEY JF, 1986, BONE MARROW TRANSPL, V1, P53
[2]  
Appleton AL, 1995, BONE MARROW TRANSPL, V16, P777
[3]  
Aversa F, 1998, BONE MARROW TRANSPL, V22, pS29
[4]   SUCCESSFUL ENGRAFTMENT OF T-CELL-DEPLETED HAPLOIDENTICAL 3-LOCI INCOMPATIBLE TRANSPLANTS IN LEUKEMIA PATIENTS BY ADDITION OF RECOMBINANT HUMAN GRANULOCYTE-COLONY-STIMULATING FACTOR-MOBILIZED PERIPHERAL-BLOOD PROGENITOR CELLS TO BONE-MARROW INOCULUM [J].
AVERSA, F ;
TABILIO, A ;
TERENZI, A ;
VELARDI, A ;
FALZETTI, F ;
GIANNONI, C ;
IACUCCI, R ;
ZEI, T ;
MARTELLI, MP ;
GAMBELUNGHE, C ;
ROSSETTI, M ;
CAPUTO, P ;
LATINI, P ;
ARISTEI, C ;
RAYMONDI, C ;
REISNER, Y ;
MARTELLI, MF .
BLOOD, 1994, 84 (11) :3948-3955
[5]  
BALDUZZI A, 1995, BLOOD, V86, P3247
[6]  
BUNJES D, 1995, BONE MARROW TRANSPL, V15, P563
[7]   UNRELATED BONE-MARROW DONOR TRANSPLANTS FOR CHILDREN WITH LEUKEMIA OR MYELODYSPLASIA [J].
CASPER, J ;
CAMITTA, B ;
TRUITT, R ;
BAXTERLOWE, LA ;
BUNIN, N ;
LAWTON, C ;
MURRAY, K ;
HUNTER, J ;
PIETRYGA, D ;
GARBRECHT, F ;
KEEVER, C ;
DROBYSKI, W ;
HOROWITZ, M ;
FLOMENBERG, N ;
ASH, R .
BLOOD, 1995, 85 (09) :2354-2363
[8]   A phase II trial of partially incompatible bone marrow transplantation for high-risk acute lymphoblastic leukaemia in children: Prevention of graft rejection with anti-LFA-1 and anti-CD2 antibodies [J].
CavazzanaCalvo, M ;
Bordigoni, P ;
Michel, G ;
Esperou, H ;
Souillet, G ;
Leblanc, T ;
Stephan, JL ;
Vannier, JP ;
Mechinaud, F ;
Reiffers, J ;
Vilmer, E ;
LandmanParker, J ;
Benkerrou, M ;
Baruchel, A ;
Pico, J ;
Bernaudin, F ;
Bergeron, C ;
Plouvier, E ;
Thomas, C ;
Wijdenes, J ;
Lacour, B ;
Blanche, S ;
Fischer, A .
BRITISH JOURNAL OF HAEMATOLOGY, 1996, 93 (01) :131-138
[9]   T-CELL DEPLETION TO PREVENT GRAFT-VERSUS-HOST DISEASE AFTER BONE-MARROW TRANSPLANTATION [J].
CHAMPLIN, R .
HEMATOLOGY-ONCOLOGY CLINICS OF NORTH AMERICA, 1990, 4 (03) :687-698
[10]  
Champlin RE, 2000, BLOOD, V95, P3996