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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of conditioning regimen on peripheral blood hematopoietic cell transplant
Michael Burns, Anurag K Singh, Carrie C Hoefer, Yali Zhang, Paul K Wallace, George L Chen, Alexis Platek, Timothy B Winslow, Austin J Iovoli, Christopher Choi, Maureen Ross, Philip L McCarthy, Theresa Hahn
Michael Burns, Carrie C Hoefer, Yali Zhang, George L Chen, Maureen Ross, Philip L McCarthy, Theresa Hahn, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
Anurag K Singh, Alexis Platek, Timothy B Winslow, Austin J Iovoli, Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
Paul K Wallace, Department of Flow Cytometry, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
Christopher Choi, Center for Immunotherapy, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
Author contributions: Burns M designed and performed the research and wrote the paper; Singh AK and Hoefer CC designed the research and supervised the report; Zhang Y and Wallace PK analyzed data; Platek A, Choi C, and Winslow TB performed the research; Iovoli AJ analyzed data and edited the report; Chen GL and Ross M provided clinical advice; McCarthy PL and Hahn T supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Roswell Park Comprehensive Cancer Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Anurag K Singh, MD, Professor, Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, United States. anurag.singh@roswellpark.org
Telephone: +1-716-8451180 Fax: +1-716-8457616
Received: July 30, 2018
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
AIM
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).
METHODS
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.
RESULTS
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).
CONCLUSION
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.
