Effect of CD34 cell dose on hematopoietic reconstitution and outcome in 508 patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation
Klaus, J and Herrmann, D and Breitkreutz, I and Hegenbart, U and Mazitschek, U and Egerer, G and Crener, FW and Lowenthal, RM and Huesing, J and Fruehauf, S and Maehler, T and Ho, AD and Goldschmidt, H, Effect of CD34 cell dose on hematopoietic reconstitution and outcome in 508 patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation, European Journal of Haematology, 78, (2) pp. 21-28. ISSN 0902-4441 (2006) [Refereed Article]
Background: We analyzed the hematopoietic reconstitution and outcome of 508 patients with multiple myeloma (MM) with respect to the number of CD34 + cells reinfused at our center. Patients and methods: Each cohort of 390 patients (unselected CD34+ cell transplant) and 118 patients (CD34+ selected transplant) was divided into four subgroups. Among the 390 transplantations, 86 patients received a high dose (HD-) of ¡Ý6.50 ¡Á 106 unselected CD34+ cells/kg, 116 patients a low dose (LD-) of <3.00 ¡Á 106 CD34+ cells/kg. Among the patients treated with CD34+ selected PBSC, 34 received ¡Ý6.50 ¡Á 106 CD34+ cells/kg (HD+) and 16 <3.00 ¡Á 106 CD34 + cells/kg (LD+). Results: HD- patients experienced a reduced median time to leukocyte (13 d vs. 14 d) (P < 0.001) and platelet reconstitution >20 ¡Á 109/L (10 d vs. 12 d) (P < 0.001). Similarly, HD+ showed a reduced median time to leukocyte (12 d vs. 15 d) (P < 0.001) and platelet recovery >20 ¡Á 10 9/L (10 d vs. 11 d) (P = 0.058). CD34+ cell-dose was significant for long-term platelet recovery at day 360 (unselected transplant P = 0.015, selected transplant P = 0.023). Number of transplanted CD34+ cells had no significant impact on transplant related mortality, overall survival or CR/PR rates within 100 d. In terms of supportive care the differences of high-/low-dose grafts were minimal. Conclusions: These results confirm that high doses of CD34+ PBSC shorten hematopoietic reconstitution and reduce hospitalization. Nevertheless secure engraftment results from transplantation of 2.00-3.00 ¡Á 106 CD34 + cells/kg. As 60% of our pretreated patients are able to collect ¡Ý5.00 ¡Á 106 CD34+ cells/kg within a single leukapheresis, division into two or more freezing bags allows safe tandem transplantation in the majority of MM patients.