ALLOGENEIC TRANSPLANTATION COMBINING MOBILIZED BLOOD AND BONE-MARROW IN PATIENTS WITH REFRACTORY HEMATOLOGIC MALIGNANCIES

Background: Mobilized blood stem cells have been used successfully in autologous transplant recipients to reduce the complications of pancyt openia due to dose-intensive chemotherapy. Reports of cytokine-mobiliz ed blood progenitor cells in allogeneic transplant recipients are rare . Study Design and Methods: This is a pilot trial of six patients. Pat ients with advanced hematologic malignancy received bone marrow (media n total 2.6 x 10(8) mononuclear cells/kg) followed by four daily trans fusions of blood (median total 9.5 x 10(8) mononuclear cells/kg) from HLA-matched sibling donors who were mobilized with recombinant human g ranulocyte-colony-stimulating factor (5 mu g/kg/day subcutaneously for 5 days). All patients received cyclosporine and prednisone for graft- versus-host disease (GVHD) prophylaxis. Results: An absolute neutrophi l count greater than 500 per mm(3) was achieved on Day 12, and platele t transfusion independence was achieved on Day 16, The median day of h ospital discharge was Day 23 after transplant. All patients achieved 1 00-percent donor cell engraftment. Acute greater than or equal to Grad e III GVHD did not develop in any patients, but all patients developed Grade I (n = 4) or Grade II (n = 2) acute GVHD. Chronic extensive GVH D developed in four of six patients. One patient died of pneumonia 263 days after transplant while undergoing immune-suppressive therapy for chronic GVHD. Conclusion: The transfusion of blood stem cells in pati ents undergoing allogeneic bone marrow transplant is well tolerated so on after transplant, but the development of chronic GVHD may limit the general usage of unmanipulated blood stem cells.