Allogeneic hematopoietic transplantation with peripheral blood progenitor cells.

Fifty three patients (pts) received an allogeneic hematopoietic transplant using peripheral blood progenitor cells (PBPC). Diagnosis were acute myeloi d leukemia (AML) in 16 pts, acute lymphoblastic leukemia (ALL) in 15, chron ic myeloid leukemia (CML) in first chronic phase in 12, aplastic anemia in 4, myelodysplasia in 3 and Hodgkin's disease, major thalasemia and Hunter's syndrome in one each. Mean age was 20 years-old (2-55), 28 males and 25 fe males. Conditioning regimens were total body irradiation with 1200 cGy and cyclophosphamide 120 mg/kg in 38 pts, busulfan 16 mg/kg and cyclophosphamid e 120 mg/kg in 10 pts, total lymphoid irradiation and cyclophosphamide in 3 , 2 pts received other chemotherapy based conditionings. PBPC were infused unmanipulated through a central catheter. Graft versus host disease (GVHD) prophylaxis was cyclosporin and short course methotrexate. Donors were 6/6 HLA compatible siblings in 52 cases and 5/6 match in one case. PBPC mobiliz ation was done with G-CSF at a dose of 10 mu g/kg/day subcutaneously for fo ur days, pheresis started on day 5. Bone marrow harvest was also done in th e first thirty cases. Mean cellularities for CD34, CD3, CD4, CD8, CD56, CD1 9 (cel x 10(6)/kg) were 4.12; 4.59; 2.57; 1.9; 0.55 and 0.68, respectively. Mean recovery of neutrophils > 500/mu L was obtained on day + 11 and plate lets > 20 000/mu L on day + 13. Patients were hospitalized for a mean perio d of 26 days (range 18-39) and days with parenteral antibiotics were 12.2 ( 5-45). Two pts had venoocclusive disease of the liver. Transplant related m ortality was 15%. Acute graft versus host disease (GVHD) was observed in 43 .4% of pts, only 5 pts had acute GVHD III or IV. Mean time for aGVHD diagno sis was +23 (8-76). Forty three pts were evaluable for chronic GVHD with a mean follow-up of 18 months (4-39). Chronic GVHD was observed in 26.4% by d ay + 240, only 2 pts developed severe cGVHD. The present experience demonst rates an acceptable incidence for cGVHD; however, taking into account recen t reports showing an increase of this complication, it seems reasonable not to perform this procedure for nonmalignant diseases in which graft versus malignancy effect is not to be expected.