Peripheral blood stem cells (PBSCs) have been used rarely for allogeneic transplantation because of concerns regarding graft failure and graft-versus-host disease (GVHD). We evaluated the results of allogeneic PBSC transplantation (allo-PBSCT) in 9 patients with refractory leukemia or lymphoma receiving myeloablative therapy followed by allo-PBSCT from an HLA-identical sibling donor. Three patients had relapsed 11 to 21 months after allogeneic bone marrow transplantation (allo-BMT) and underwent allo-PBSCT using the same donor. Six patients received PBSCs as their initial allogeneic transplant. Filgrastim-mobilized PBSCs were collected from the donors in 3 to 4 aphereses and cryopreserved. The apheresis collections contained a median nucleated cell count of 16.5 x 10(8)/kg (range, 10.8 to 28.7 x 10(8), 10.7 x 10(6) CD34+ cells/kg (range, 7.5 to 22.5 x 10(6)), and 300.0 x 10(6) CD3+ cells/kg (range, 127.8 to 1,523.2 x 10(6)). The median recovery of CD34+ progenitor cells after freezing, thawing, and washing was 106.4% (range, 36.7% to 132.0%). All patients received filgrastim posttransplant through engraftment, and cyclosporine and methylprednisolone were used for GVHD prophylaxis. Neutrophil recovery to greater than 0.5 x 10(9)/L and greater than 1.0 x 10(9)/L occurred at a median of 9 (range, 8 to 10) and 9 days (range, 8 to 11) posttransplant, respectively, which was similar to historical controls after allo-BMT and granulocyte colony-stimulating factor therapy. Platelets recovered to greater than 20 x 10(9)/L and greater than 50 x 10(9)/L at a median of 12 (range, 8 to 25) and 15 days (range, 11 to 59), respectively, which was significantly more rapid than for the controls (P < .01). Donor cell engraftment was documented by cytogenetics, fluorescence in situ hybridization, and/or restriction fragment length polymorphisms with longest follow-up of 283 + days. Three patients developed grade 2 acute GVHD involving only the skin. Three of five evaluable patients show limited chronic GVHD. Cryopreserved, filgrastim-stimulated allogeneic PBSCs may be a suitable alternative to allogeneic marrow for transplantation with the advantage of more rapid platelet recovery. Acute GVHD was minimal despite the infusion of 1 log more CD3 cells than with marrow allografts. Further studies are required to assess long-term risks of chronic GVHD.
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ARTICLES|
March 15, 1995
Allogeneic blood stem cell transplantation for refractory leukemia and lymphoma: potential advantage of blood over marrow allografts [see comments]
M Korbling,
M Korbling
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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D Przepiorka,
D Przepiorka
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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YO Huh,
YO Huh
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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H Engel,
H Engel
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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K van Besien,
K van Besien
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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S Giralt,
S Giralt
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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B Andersson,
B Andersson
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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HD Kleine,
HD Kleine
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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D Seong,
D Seong
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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AB Deisseroth
AB Deisseroth
Section of Bone Marrow Transplantation, U.T.M.D. Anderson Cancer Center, Houston 77030.
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Blood (1995) 85 (6): 1659–1665.
Citation
M Korbling, D Przepiorka, YO Huh, H Engel, K van Besien, S Giralt, B Andersson, HD Kleine, D Seong, AB Deisseroth; Allogeneic blood stem cell transplantation for refractory leukemia and lymphoma: potential advantage of blood over marrow allografts [see comments]. Blood 1995; 85 (6): 1659–1665. doi: https://doi.org/10.1182/blood.V85.6.1659.bloodjournal8561659
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March 15 1995
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