ALLOGENEIC PERIPHERAL STEM-CELL TRANSPLANTATION USING POSITIVELY SELECTED CD34(-MISMATCHED DONORS() CELLS FROM HLA)

Citation
Y. Matsuda et al., ALLOGENEIC PERIPHERAL STEM-CELL TRANSPLANTATION USING POSITIVELY SELECTED CD34(-MISMATCHED DONORS() CELLS FROM HLA), Bone marrow transplantation, 21(4), 1998, pp. 355-360
Citations number
26
Categorie Soggetti
Hematology,Oncology,Immunology,Transplantation
Journal title
ISSN journal
02683369
Volume
21
Issue
4
Year of publication
1998
Pages
355 - 360
Database
ISI
SICI code
0268-3369(1998)21:4<355:APSTUP>2.0.ZU;2-Y
Abstract
We examined five children who underwent allogeneic peripheral stem cel l transplantation (PSCT) using positively selected CD34(+) cells from three or two loci-mismatched donors, CD34(+) cells mobilized from peri pheral blood were separated by immunomagnetic beads, CD34(+) cells at 2.2-6.2 x 10(6)/kg were transplanted into three patients with refracto ry leukemia, a patient with relapsed medulloblastoma and a patient wit h Fanconi's anemia following a conditioning regimen which included irr adiation, alkylating agents and antithymocyte globulin treatment, The number of infused CD3(+) cells included in grafts was 2.3-22.7 x 10(4) /kg. Four patients achieved engraftment and hematopoietic reconstituti on (>5 x 10(8)/l of neutrophils on day 10 or 11), Graft rejection was observed in the patient with Fanconi's anemia, but a rapid engraftment was obtained after second PSCT, Although no prophylactic agents other than ATG (included in the conditioning regimen) were used, greater th an grade I acute GVHD was not observed, but limited chronic GVHD was o bserved in two patients, The two patients with leukemia relapsed on da ys 103 and 210, respectively, and the patient with medulloblastoma die d of disease on day 159, The patient with Fanconi's anemia died of fun gal infection, CMV and HHV-6 diseases developed in four and two patien ts, respectively, Thus, although SCT using positively selected periphe ral CD34(+) cells may be an alternative approach for overcoming graft rejection and GVHD from HLA-mismatched donors, persistent immune defic iency attributing to extremely low numbers of T cells in grafts can po tentially lead to reactivation of herpes viruses.