Low incidence of severe aGVHD and accelerating hemopoietic reconstitution in Allo-BMT using lenograstim stimulated BM cells

Objectives To investigate the efficacy of accelerating hemopoietic reconstr action and reducing a graft versus host disease (GVHD) in Allo-BMT receivin g lenograstim stimulated donor marrow and to assess the preliminary biologi cal mechanism. Methods The donors for thirty patients (study group) with leukemia were giv en lenograstim 3-4 mug . kg(-1) . d(-1) for seven days prior to marrow harv est. The results of subsequent engraftment in the recipients was compared w ith fifteen donors without G-CSF (control group). Five donors themselves we re studied to assess the effects of lenograstion on hematopoietic progenito r cells and lymphocyte subsets in BM. Results The stimulated bone marrow contained a higher number of nucleated c ells, CFU-GM and CD34(+) cells (P<0.01). The hematopoetic reconstitution wa s accelerated. Until granulocyte counts exceeded 0.5 x10(9)/L and plalete c ounts exceeded 20 x 10(9)/L, the days were 16.7 +/- 3.2 and 18.4 +/- 3.0 da ys as compared with those of the control group (22.5 +/- 5.1 and 26.3 +/- 5 .9 days respectively, P < 0.01). The incidence of grade II - IV aGVHD was v ery low, only one case with grade II aGVHD on the skin in the study group. Four out of fifteen patients (26.7%) in the control group had grade II-IV a GVHD (P<0.05). The number of T lymphocyte subsets in the harvested BM stimu lated by G-CSF changed. In comparison with the control group, CD4(+) decrea sed and CD8(+) increased significantly ( P< 0.01). The changes of progenito r cells and T lymphocyte subsets in BM from pre- to post- G-CSF stimulation indicated that the percentage of CD4(+) cells reduced (P < 0.05), that of CD8(+) cells, and that of CD34(+) increased (P < 0.01). The incidence of ch ronic GVHD and relapse of leukemia were not different significantly between both groups. Conclusions Allogenic bone marrow transplant (Allo-BMT) donors given G-CSF can accelerate engraftment and minimize the incidence of severe aGVHD. Ther e is a trend in favour of improved transplant-related complications.