Change of apheresis device decreased the incidence of severe acute graft-versus-host disease among patients after allogeneic stem cell transplantation with sibling donors
| Autor: | Emma Watz, Michael Uhlin, M Remberger, Andreas T. Björklund, T. Wang, Jonas Mattsson, U. Axdorph Nygell, Mikael Sundin |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty CD3 Complex medicine.medical_treatment Immunology Treatment outcome Graft vs Host Disease Hematopoietic stem cell transplantation 030204 cardiovascular system & hematology Gastroenterology 03 medical and health sciences 0302 clinical medicine Antigens CD Recurrence Internal medicine Acute graft versus host disease medicine Immunology and Allergy Humans Transplantation Homologous Lymphocyte Count Sibling Peripheral Blood Stem Cell Transplantation business.industry Incidence (epidemiology) Incidence Hematology Middle Aged Survival Analysis Tissue Donors Transplantation surgical procedures operative Apheresis Acute Disease Blood Component Removal Female Stem cell business 030215 immunology |
| Zdroj: | Transfusion. 58(6) |
| ISSN: | 1537-2995 |
| Popis: | The composition of the graft used for allogeneic hematopoietic stem cell transplantation (HSCT) is important for the treatment outcome. Different apheresis devices may yield significant differences in peripheral blood stem cell graft cellular composition. We compared stem cell grafts produced by Cobe Spectra (Cobe) and Spectra Optia (Optia) with use of the mononuclear cell (MNC) protocol, and evaluated clinical outcome parameters such as graft-versus-host disease (GvHD), transplant-related mortality (TRM), relapse, and overall survival.During 5 years, 31 Cobe Spectra and 40 Spectra Optia grafts were analyzed for CD34, CD3, CD4, CD8, CD19, and CD56 cell content. Clinical outcome parameters were correlated and compared between the two patient groups using different apheresis devices.Optia grafts contained fewer lymphocytes compared to Cobe (p 0.001). Optia grafts had a significantly lower incidence of acute GvHD Grades II through IV (Cobe 45% vs. Optia 23%; p = 0.039) and TRM (16% vs. 2.5%; p 0.05) but higher chronic GvHD (32% vs. 67%; p = 0.005) compared to Cobe grafts. Finally, the multivariate analysis showed a significant correlation among the different apheresis devices and both acute GvHD II through IV and severe chronic GvHD. The multivariate analysis also showed a significant correlation between the CD3+ cell dose and the incidence of severe acute GvHD.Optia-obtained grafts yielded a lower acute GvHD Grades II-IV and TRM risk, but had no impact on relapse or overall survival in this study. Understanding and further improvement of peripheral blood stem cell (PBSC) apheresis techniques may be used in the future to personalize HSCT by, for example, fine-tuning the GvHD incidence. |
| Databáze: | OpenAIRE |
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