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Annals of Hematology
Published in: Annals of Hematology 5/2005

01-05-2005 | Original Article

Reduced-intensity conditioning followed by allografting of CD34-selected stem cells and ≤106/kg T cells may have an adverse effect on transplant-related mortality

Authors: Udo F. Hartwig, Nils Winkelmann, Thomas Wehler, Sebastian Kreiter, Peter M. Schneider, Ralf G. Meyer, Andrew J. Ullmann, Christoph Huber, Karin Kolbe, Wolfgang Herr

Published in: Annals of Hematology | Issue 5/2005

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Abstract

In patients undergoing allogeneic peripheral blood stem cell (PBSC) transplantation after reduced-intensity conditioning (RIC), graft-versus-host disease (GVHD) represents a major cause of morbidity and mortality. T-cell depletion (TCD) prevents GVHD but carries potential risks of graft failure, opportunistic infections, and disease relapse. We explored ex vivo TCD of stem cell allografts that were administered after RIC treatment. Thirteen high-risk patients with hematological malignancies were treated with a fludarabine/melphalan-based RIC regimen followed by transplantation of immunomagnetically selected CD34+ PBSC from HLA-identical sibling or matched unrelated donors. Patients were sequentially enrolled in two cohorts: group A (n=6) received antithymocyte globulin (ATG) during conditioning and 105 donor T cells/kg at transplantation, while group B (n=7) received 106 donor T cells/kg without ATG pretreatment. Primary graft failure occurred in two patients of group A and in one patient of group B. Complete donor chimerism persisting more than 1 year was achieved in two cases per cohort. Acute grade II to IV or chronic extensive GVHD were observed in a total of six patients (group A, 2; group B, 4). Procedure-related deaths were mainly due to severe pneumonia occurring in two patients of group A and in five patients of group B. These results suggest that CD34 selection of reduced-intensity PBSC allografts may cause adverse effects upon specific antimicrobial immunity which can lead to fatal infections, particularly in high-risk patients. In our study, simultaneous add-back of ≤106/kg donor T cells was unable to compensate for this deficiency.
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Metadata
Title
Reduced-intensity conditioning followed by allografting of CD34-selected stem cells and ≤106/kg T cells may have an adverse effect on transplant-related mortality
Authors
Udo F. Hartwig
Nils Winkelmann
Thomas Wehler
Sebastian Kreiter
Peter M. Schneider
Ralf G. Meyer
Andrew J. Ullmann
Christoph Huber
Karin Kolbe
Wolfgang Herr
Publication date
01-05-2005
Publisher
Springer-Verlag
Published in
Annals of Hematology / Issue 5/2005
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-004-1001-5

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