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Non-Myeloablative Stem Cell Transplantation

High stem cell dose will not compensate for T cell depletion in allogeneic non-myeloablative stem cell transplantation

Bone Marrow Transplantation volume 30, pages 267–271 (2002)Cite this article

Abstract

The best strategies for non-myeloablative stem cell transplants (NST) are not known. We hypothesized that a high stem cell dose and post-transplant donor lymphocyte infusions (DLI) in a T cell-depleted NST setting may result in stable engraftment without severe GvHD. We used conditioning with 200 mg/kg cyclophosphamide, and ATG, a high peripheral stem cell dose of >10 × 106 CD34+ cells/kg, T cell-depleted to <1 × 105 CD3+ cells/kg followed by incremental DLI. Ten patients, 53 (42–61) years of age with hematological malignancy (CML in 3, MDS in 2, myeloma in 3 and CLL in 2) were included. All patients achieved initial engraftment, at a median 13.5 (10–20) days. Three patients achieved complete chimerism, four achieved a complete hematologic remission. In seven patients the graft ultimately failed. Acute GvHD grade II was seen in three patients after DLI. At a median follow-up of 28 months (range 15–35), eight patients are alive, none died of treatment-related complications. NST with T cell depletion to prevent GVHD results in a high graft failure rate. High stem cell dose (⩾10 × 106 CD34+cells/kg) and post-transplant DLI will not compensate for the lack of T cells to ensure stable engraftment.

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Acknowledgements

In part supported by the Swiss national research foundation grant NF No. 32-52756.97

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Basel University Hospital, Switzerland

    JR Passweg, S Meyer-Monard, M Gregor, G Favre, D Heim, M Ebnoether, A Tichelli & A Gratwohl

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  1. JR Passweg
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  2. S Meyer-Monard
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  3. M Gregor
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  4. G Favre
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  7. A Tichelli
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  8. A Gratwohl
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Passweg, J., Meyer-Monard, S., Gregor, M. et al. High stem cell dose will not compensate for T cell depletion in allogeneic non-myeloablative stem cell transplantation. Bone Marrow Transplant 30, 267–271 (2002). https://doi.org/10.1038/sj.bmt.1703671

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