Impact of donor-derived CD34 + infused cell dose on outcomes of patients undergoing allo-HCT following reduced intensity regimen for myelofibrosis: a study from the Chronic Malignancies Working Party of the EBMT
Czerw, Tomasz; Iacobelli, Simona; Malpassuti, Vittoria; Koster, Linda; Kröger, Nicolaus; Robin, Marie; Maertens, Johan; Chevallier, Patrice; Watz, Emma; Poiré, Xavier; Snowden, John A.; Kuball, Jürgen; Kinsella, Francesca; Blaise, Didier; Reményi, Péter; Mear, Jean Baptiste; Cammenga, Jörg; Rubio, Marie Thérèse; Maury, Sebastien; Daguindau, Etienne; Finnegan, Damian; Hayden, Patrick; Hernández-Boluda, Juan Carlos; McLornan, Donal; Yakoub-Agha, Ibrahim
(2022) Bone Marrow Transplantation, volume 57, issue 2, pp. 261 - 270
(Article)
Abstract
The optimal CD34 + cell dose in the setting of RIC allo-HCT for myelofibrosis (MF) remains unknown. We retrospectively analyzed 657 patients with primary or secondary MF transplanted with use of peripheral blood (PB) stem cells after fludarabine/melphalan or fludarabine/busulfan RIC regimen. Median patient age was 58 (range, 22–76) years.
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Donors were HLA-identical sibling (MSD) or unrelated (UD). Median follow-up was 46 (2–194) months. Patients transplanted with higher doses of CD34 + cells (>7.0 × 106/kg), had an increased chance of achievement of both neutrophil (hazard ratio (HR), 1.46; P < 0.001) and platelet engraftment (HR, 1.43; P < 0.001). In a model with interaction, for patients transplanted from a MSD, higher CD34 + dose was associated with improved overall survival (HR, 0.63; P = 0.04) and relapse-free survival (HR, 0.61; P = 0.02), lower risk of non-relapse mortality (HR, 0.57; P = 0.04) and higher rate of platelet engraftment. The combined effect of higher cell dose and UD was apparent only for higher neutrophil and platelet recovery rate. We did not document any detrimental effect of high CD34 + dose on transplant outcomes. More bulky splenomegaly was an adverse factor for survival, engraftment and NRM. Our analysis suggests a potential benefit for MF patients undergoing RIC PB-allo-HCT receiving more than 7.0 × 106/kg CD34 + cells.
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Keywords: Hematology, Transplantation
ISSN: 0268-3369
Publisher: Nature Publishing Group
Note: Funding Information: The authors would like to thank all investigators and data managers in the EBMT participating centers for their contribution to this analysis. Detailed list is presented in?Supplementary Appendix. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Nature Limited.
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