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
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.