Absence of influence of peripheral blood CD34+ and CD3+ graft cell counts on outcomes after reduced-intensity conditioni
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ORIGINAL ARTICLE
Absence of influence of peripheral blood CD34+ and CD3+ graft cell counts on outcomes after reduced-intensity conditioning transplantation using post-transplant cyclophosphamide Alice Garnier 1 & Thierry Guillaume 1 & Pierre Peterlin 1 & Amandine Le Bourgeois 1 & Béatrice Mahé 1 & Viviane Dubruille 1 & Nicolas Blin 1 & Cyrille Touzeau 1 & Thomas Gastinne 1 & Anne Lok 1 & Benoit Tessoulin 1 & Alix Duquesne 2 & Marion Eveillard 3 & Steven Le Gouill 1 & Philippe Moreau 1 & Marie C. Béné 3 & Patrice Chevallier 1,4 Received: 22 September 2019 / Accepted: 10 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The influence of peripheral blood stem cell (PBSC) graft cell contents after transplant with post-transplant cyclophosphamide (PTCY) remains unclear. Here, we retrospectively report on a cohort of 77 adults who received a Baltimore-based reducedintensity conditioning regimen either with fludarabine (n = 40) or clofarabine (n = 37) and PTCY. With a median follow-up of 29.2 months, [2-]year overall (OS), disease-free (DFS), and GVHD/relapse-free survival (GRFS) rates were 62.8%, 51%, and 36.7%, respectively. The incidence of grades [2–]4 acute GVHD was significantly higher in patients transplanted with a haplodonor (n = 56), at 57.1% vs 19% (p = 0.006). PBSC graft cell contents (CD45+, CD34+, and CD3+ cells) had no impact on any outcome. Considering immune reconstitution until 1 year, only monocytes were above the normal range (as early as day + 30) during the first year post-transplant. In multivariate analysis, an older donor (> 45 years) and a high/very high disease risk index were independently associated with lower OS. A higher monocyte count (> median) at day + 90 was also associated with better OS, DFS, and GRFS. Donor/recipient CMV status matching was independently associated with GRFS. In conclusion, our data support the fact that there is no need to manipulate the graft before infusion in the particular context of PBSC/PTCY Baltimore-based allotransplant. Keywords Allogeneic stem cell transplantation . CD45 . CD34 . CD3 . Clofarabine . RIC . PTCY . Immune reconstitution . Haploidentical
Introduction Allogeneic hematopoietic stem cell transplantation (alloHSCT) with high-dose post-transplant cyclophosphamide (PTCY) for graft-versus-host disease (GVHD) prophylaxis is Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04031-4) contains supplementary material, which is available to authorized users. * Patrice Chevallier [email protected] 1
Hematology Department, CHU Hotel-Dieu, Nantes, France
2
Cellular Engineering Unit, EFS Pays de la Loire, Nantes, France
3
Hematology/Biology, CHU Hotel-Dieu, Nantes, France
4
Service d’Hématologie Clinique, CHU Hotel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France
currently used, not only for patients with haploidentical donors [1] but also for those with matched donors [2, 3]. Indeed, both acute and chronic GVHD are significantly reduced with the
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