Published online Feb 24, 2019. doi: 10.5306/wjco.v10.i2.86
Peer-review started: July 30, 2018
First decision: September 11, 2018
Revised: September 14, 2018
Accepted: December 4, 2018
Article in press: December 5, 2018
Published online: February 24, 2019
Processing time: 207 Days and 10.7 Hours
To investigate infused hematopoietic cell doses and their interaction with conditioning regimen intensity +/- total body irradiation (TBI) on outcomes after peripheral blood hematopoietic cell transplant (PBHCT).
Our retrospective cohort included 247 patients receiving a first, T-replete, human leukocyte antigen-matched allogeneic PBHCT and treated between 2001 and 2012. Correlations were calculated using the Pearson product-moment correlation coefficient. Overall survival and progression free survival curves were generated using the Kaplan-Meier method and compared using the log-rank test.
Neutrophil engraftment was significantly faster after reduced intensity TBI based conditioning [reduced intensity conditioning (RIC) + TBI] and > 4 × 106 CD34+ cells/kg infused. A higher total nucleated cell dose led to a higher incidence of grade II-IV acute graft-versus-host disease in the myeloablative + TBI regimen group (P = 0.03), but no significant difference in grade III-IV graft-versus-host disease. A higher total nucleated cell dose was also associated with increased incidence of moderate/severe chronic graft-versus-host disease, regardless of conditioning regimen. Overall and progression-free survival were significantly better in patients with a RIC + TBI regimen and total nucleated cell dose > 8 × 108/kg (3 years, overall survival: 70% vs 38%, P = 0.02, 3 years, progression free survival: 64% vs 38%, P = 0.02).
TBI and conditioning intensity may alter the relationship between infused cell doses and outcomes after PBHCT. Immune cell subsets may predict improved survival after unmanipulated PBHCT.
Core tip: This study investigated infused hematopoietic cell doses and their interaction with conditioning regimen intensity on outcomes after peripheral blood hematopoietic cell transplant. Our retrospective cohort included 247 patients receiving a first, T-replete, human leukocyte antigen-matched allogeneic peripheral blood hematopoietic cell transplant. Neutrophil engraftment was significantly faster after reduced intensity total body irradiation and > 4 × 106 CD34+ cells/kg infused. Overall and progression-free survival was significantly better in patients with a reduced intensity conditioning and total body irradiation regimen and total nucleated cell dose > 8 × 108/kg.