Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Stem Cell Collection

The inferiority of G-PB to rhG-CSF-mobilized blood and marrow grafts as a stem cell source in patients with high-risk acute leukemia who underwent unmanipulated HLA-mismatched/haploidentical transplantation: a comparative analysis

Bone Marrow Transplantation volume 45, pages 985–992 (2010)Cite this article

Abstract

The purpose of this study was to investigate the efficacy and feasibility of unmanipulated haploidentical PBSCT for the treatment of acute leukemia (AL). This study compares the clinical outcomes of high-risk AL patients who received PBSCs harvested from family members sharing at least one common haplotype to outcomes of high-risk AL patients who received a mixture of G-CSF-primed BM (G-BM) and peripheral blood (G-PB) harvests. The results show that PBSCT achieved inferior cumulative myeloid engraftment at 30 days after transplant (89.9±10.1% vs 100%; P=0.04), with lower cumulative incidence of grade II–IV acute GVHD (aGVHD) (37.1±16.5% vs 63.2±6%; P=0.058) compared with G-BM/G-PB transplant. However, both transplant protocols had similar rates of 2-year relapse (29.6±17.1% vs 34.0±5.7%; P=0.954), and PBSCT produced a higher incidence of 2-year non-leukemic mortality (62.5±14.8% vs 35.1±5.1%; P=0.014), as well as lower rates of overall (26.8±12.3% vs 43.2±5.0%; P=0.052) and disease-free survival (26.8±12.3% vs 42.4±5.0%; P=0.071) compared with G-BM/G-PB transplant. These results suggest that haploidentical HSCT is an option for patients with AL who urgently need a graft and do not have matched sibling donors. PBSCT is potentially inferior to G-BM/G-PB transplant, and improvements should be made before PBSCT becomes a routine in unmanipulated mismatched/haploidentical transplant settings.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Similar content being viewed by others

References

  1. Burnett AK, Wheatley K, Goldstone AH, Stevens RF, Hann IM, Rees JH et al. The value of allogeneic bone marrow transplant in patients with acute myeloid leukaemia at differing risk of relapse: results of the UK MRC AML 10 trial. Br J Haematol 2002; 118: 385–400.

    Article  PubMed  Google Scholar 

  2. Schipper RF, D'Amaro J, Bakker JT, Bakker J, van Rood JJ, Oudshoorn M . HLA gene haplotype frequencies in bone marrow donors worldwide registries. Hum Immunol 1997; 52: 54–71.

    Article  CAS  PubMed  Google Scholar 

  3. Gluckman E, Rocha V, Chevret S . Results of unrelated umbilical cord blood hematopoietic stem cell transplantation. Rev Clin Exp Hematol 2001; 5: 87–99.

    Article  CAS  PubMed  Google Scholar 

  4. Liu D, Huang X, Liu K, Xu L, Chen H, Han W et al. Haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for treatment of hematological malignancies in children. Biol Blood Marrow Transplant 2008; 14: 469–477.

    Article  CAS  PubMed  Google Scholar 

  5. Huang XJ, Han W, Xu LP, Chen YH, Liu DH, Lu J et al. A novel approach to human leukocyte antigen-mismatched transplantation in patients with malignant hematological disease. Chin Med J (Engl) 2004; 117: 1778–1785.

    Google Scholar 

  6. Huang XJ, Liu DH, Liu KY, Xu LP, Chen H, Han W et al. Haploidentical hematopoietic stem cell transplantation without in vitro T-cell depletion for the treatment of hematological malignancies. Bone Marrow Transplant 2006; 38: 291–297.

    Article  PubMed  Google Scholar 

  7. Wang F, Huang X, Ren H, Zhang Y, Xu L, Chen Y et al. [Allogeneic peripheral blood stem cell transplantation in the treatment of hematologic malignancies]. Zhonghua Xue Ye Xue Za Zhi 2002; 23: 403–406.

    PubMed  Google Scholar 

  8. Arcese W, Aversa F, Bandini G, De Vincentiis A, Falda M, Lanata L et al. Clinical use of allogeneic hematopoietic stem cells from sources other than bone marrow. Haematologica 1998; 83: 159–182.

    CAS  PubMed  Google Scholar 

  9. Zhao XY, Huang XJ, Liu KY, Xu LP, Liu DH . Prognosis after unmanipulated HLA-haploidentical blood and marrow transplantation is correlated to the numbers of KIR ligands in recipients. Eur J Haematol 2007; 78: 338–346.

    Article  CAS  PubMed  Google Scholar 

  10. Aversa F, Terenzi A, Tabilio A, Falzetti F, Carotti A, Ballanti S et al. Full haplotype-mismatched hematopoietic stem-cell transplantation: a phase II study in patients with acute leukemia at high risk of relapse. J Clin Oncol 2005; 23: 3447–3454.

    Article  PubMed  Google Scholar 

  11. Rizzieri DA, Koh LP, Long GD, Gasparetto C, Sullivan KM, Horwitz M et al. Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution. J Clin Oncol 2007; 25: 690–697.

    CAS  PubMed  Google Scholar 

  12. Huang XJ, Liu DH, Liu KY, Xu LP, Chen YH, Wang Y et al. Modified donor lymphocyte infusion after HLA-mismatched/haploidentical T cell-replete hematopoietic stem cell transplantation for prophylaxis of relapse of leukemia in patients with advanced leukemia. J Clin Immunol 2008; 28: 276–283.

    Article  CAS  PubMed  Google Scholar 

  13. Huang XJ, Wang Y, Liu DH, Xu LP, Chen H, Chen YH et al. Modified donor lymphocyte infusion (DLI) for the prophylaxis of leukemia relapse after hematopoietic stem cell transplantation in patients with advanced leukemia—feasibility and safety study. J Clin Immunol 2008; 28: 390–397.

    Article  CAS  PubMed  Google Scholar 

  14. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  15. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  PubMed  Google Scholar 

  16. Takahashi S, Ooi J, Tomonari A, Konuma T, Tsukada N, Oiwa-Monna M et al. Comparative single-institute analysis of cord blood transplantation from unrelated donors with bone marrow or peripheral blood stem-cell transplants from related donors in adult patients with hematologic malignancies after myeloablative conditioning regimen. Blood 2007; 109: 1322–1330.

    Article  CAS  PubMed  Google Scholar 

  17. Zhao XY, Chang YJ, Xu LP, Liu DH, Liu KY, Huang XJ . Association of natural killer cells in allografts with transplant outcomes in patients receiving G-CSF-mobilized PBSC grafts and G-CSF-primed BM grafts from HLA-haploidentical donors. Bone Marrow Transplant (e-pub ahead of print 20 April 2009; doi:10.1038/bmt.2009.73).

    Article  PubMed  Google Scholar 

  18. Zhao XY, Huang XJ . [Influence factors of reconstitution of killer cell immunoglobulin-like receptor on NK cells following non-T-cell-depleted haploidentical hematopoietic stem cell transplantation]. Zhonghua Xue Ye Xue Za Zhi 2007; 28: 103–106.

    PubMed  Google Scholar 

  19. Huang XJ, Liu DH, Liu KY, Xu LP, Chen H, Han W et al. Treatment of acute leukemia with unmanipulated HLA-mismatched/haploidentical blood and bone marrow transplantation. Biol Blood Marrow Transplant 2009; 15: 257–265.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Outstanding Young Scientists' Foundation of China (Grant no. 30725038), the Program for Innovative Research Team in University (IRT0702) and the HI-Tech Research Development Program of China 863 (Grant no. 2006AA02Z4A0). We thank every faculty member who has participated in these studies. We thank Dr Axel R Zander for assisting in editing the paper. We thank Xiangyu Zhao, MD, PhD, for her helpful comments on the statistics. We also thank Liu Yan-Rong and Ya-Zhen Qin, PhD for excellent laboratory support for the MRD test.

Author information

Authors and Affiliations

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

    L-P Xu, K-Y Liu, D-H Liu, H Chen, W Han, Y-H Chen, Y Wang & X-J Huang

Authors
  1. L-P Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K-Y Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D-H Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y-H Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. X-J Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to X-J Huang.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xu, LP., Liu, KY., Liu, DH. et al. The inferiority of G-PB to rhG-CSF-mobilized blood and marrow grafts as a stem cell source in patients with high-risk acute leukemia who underwent unmanipulated HLA-mismatched/haploidentical transplantation: a comparative analysis. Bone Marrow Transplant 45, 985–992 (2010). https://doi.org/10.1038/bmt.2009.311

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.311

Keywords

This article is cited by

Search

Advanced search

Quick links