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Prophylactic infusion of donor granulocyte colony stimulating factor mobilized peripheral blood progenitor cells after allogeneic hematological stem cell transplantation in patients with high-risk leukemia

Leukemia volume 20, pages 365–368 (2006)Cite this article

Adult patients with advanced hematological malignancies after allogeneic hematopoietic stem cell transplantation (allo-HSCT) have a poor prognosis because of high rate of relapse. For patients with recurrent disease, salvage chemotherapy or intensive conditioning followed by a second HSCT may be applied; however, aggressive chemotherapy for patients who relapse within 100 days after transplantation is associated with a high mortality and a low rate of complete remission. Even in case of late relapse, long-term survivors are few, although temporary complete remissions (CR) have been restored. Donor lymphocyte infusion (DLI) is regarded as one of the main therapeutic options for relapsed hematological malignancies after allo-HSCT. However, its effect has been confirmed only in early-stage of chronic myelogenous leukemia (CML) in contrast to advanced-stage of CML and other refractory hematological malignancies. Prophylactic DLI exhibited definite effect on the patients with highly aggressive hematological malignancies that had short doubling time. It is also known that DLI could be followed by high rate of severe graft-versus-host disease (GVHD), sometimes, pancytopenia and infection.1 Many studies have demonstrated that in vivo granulocyte colony stimulating factor (G-CSF) could modify the function of lymphocytes in peripheral blood harvest.2, 3 Recently, we reported that the infusion of donor G-CSF-mobilized peripheral blood progenitor cells (GPBPC) instead of donor lymphocytes showed a super-antileukemic effect and this approach may accompany the decrease of infusion-related GVHD and rarely be complicated with pancytopenia.4 So, we hypothesize that the prophylactic GPBPC infusion can induce antileukemic effect and lower the incidence of relapse with more safety. Here, we report the preliminary results from trials of allo-HSCT followed by planned prophylactic GPBPC infusion in patients with high-risk hematological malignancies.

From May 2001 to March 2004, 24 patients with hematological malignancies who had a high risk of relapse were allocated on an intend-to-treat basis to allo-HSCT followed by prophylactic GPBPC infusion. All the healthy donors and the recipients signed the consent form for stem cell collection and transplantation and stem cell cryopreservation for later prophylactic GPBPC infusion. Hematological malignancies with high risk of relapse were defined as acute leukemia in the first complete remission (CR1) with unfavorable cytogenetic abnormalities such as positive Ph chromosome, acute leukemia in more than CR1 status or in nonremission state, CML in accelerate phase (AP) and blast crisis (BC), myelodyplastic syndrome-refractory anemia with excess blast (MDS-RAEB) and primary refractory lymphoma. Among the 24 patients, seven were AML in nonremission state, one was in the third CR, five were ALL in nonremission state, three were Ph+ALL in CR1 after Glivec therapy, six patients were CML in AP and BC, the other two patient were MDS-RAEB. All patients underwent HLA identical-sibling transplantation. The source of stem cells were G-CSF mobilized peripheral blood stem cells (PBSCs) for 13 patients and the mixture of G-CSF-mobilized bone marrow cells and PBSCs for the other 11 patients. The median age of the 24 HSCT recipients was 32 years (range, 12–64 years).

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Acknowledgements

This study was supported by the National Natural Science Foundation of China and the Foundation of Chinese Ministry of Health.

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  1. Peking University Institute of Hematology, People's Hospital, Beijing, 100044, China

    X-j Huang, D-h Liu, L-p Xu, H Chen, W Han, K-y Liu & D-p Lu

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Huang, Xj., Liu, Dh., Xu, Lp. et al. Prophylactic infusion of donor granulocyte colony stimulating factor mobilized peripheral blood progenitor cells after allogeneic hematological stem cell transplantation in patients with high-risk leukemia. Leukemia 20, 365–368 (2006). https://doi.org/10.1038/sj.leu.2403995

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