Transplantation of highly purified CD34(+)Thy-I+ hematopoietic stem cells in patients with metastatic breast cancer

We report here the transplantation of extensively purified "mobilized" peri pheral blood CD34(+)Thy-1(+) hematopoietic stem cells from 22 patients with recurrent or metastatic breast cancer. patients were mobilized with either high-dose granulocyte colony-stimulating factor (G-CSF) alone or cyclophos phamide plus G-CSF. Median purity of the stem cell product at cryopreservat ion was 95.3% (range, 91.1%-98.3%), and viability was 98.6% (range, 96.5%-1 00%). After high-dose chemotherapy with carmustine, cisplatin, and cyclopho sphamide, CD34(+)Thy-1(+) cells at a median dose of 11.3 x 10(5) per kilogr am (range, 4.7-163 x 10(5) per kilogram) were infused. No infusion-related toxicity was observed. Neutrophil recovery was prompt, with median absolute neutrophil count >500/muL by day 10 (range, 8-15 days) and >1000/muL by da y 11 (range, 8-17 days). Median platelet recovery (>20,000/muL) was observe d by day 14 (range, 9-42 days) and >50,000/muL, by day 17 (range, 11-49 day s). Tumor cell depletion below the limits of detection of a sensitive immun ofluorescence-based assay was accomplished in all patients who had detectab le tumor cells in apheresis products before processing. Although CD4(+) T-c ell reconstitution was slow, no unusual infections were observed. Neither e arly nor late graft failure was observed, and no patient required infusion of unmanipulated backup cells. At a median follow-up of approximately 1.4 y ears and a maximum follow-up of 2.5 years, 16 of the 22 patients remain ali ve, with 9 free of disease progression, and have stable blood counts. In su mmary, highly purified CD34(+)Thy-1(+) cells used as the sole source of the hematopoietic graft result in rapid and sustained hematopoietic engraftmen t.