Abstract
Background aims
In a previous pilot study of HLA-matched sibling donor hematopoietic cell transplantation
(HCT), the authors determined the feasibility of day 4 versus day 5 granulocyte colony-stimulating
factor (G-CSF)-mobilized peripheral blood stem cell (PBSC) collection compared with
a historical cohort. Given identified differences in the PBSC product (day 4 cohort
with significantly lower infused total nucleated, mononuclear and CD3 cells compared
with other collection cohorts), the authors performed a follow-up study to determine
long-term post-HCT outcomes, including detailed characterization of chronic graft-versus-host
disease (GVHD).
Methods
This was a prospective observational study, and the authors collected data on chronic
GVHD, staging, sites of involvement and treatments. Performance status, incidence
of relapse, overall survival and duration of immunosuppressive therapy (IST) were
also evaluated. Data were examined retrospectively. To account for differences in
length of follow-up among cohorts, the authors also determined performance status
and chronic GVHD staging, sites and treatment at 2 years post-HCT.
Results
At 2 years post-HCT, the overall survival rate was 71.7% in the day 4 cohort compared
with 61.5%, 52% and 56% in the day 5, 2-day and historical cohorts, respectively (P = 0.283). The cumulative incidence of chronic GVHD was 65.2% in the day 4 cohort
versus 46.4% in the day 5 cohort, 51.1% in the 2-day cohort and 65% in the historical
cohort (P = 0.26). There was no significant difference in the maximum overall stage of chronic
GVHD (P = 0.513), median number of sites involved (P = 0.401) or cumulative incidence of discontinuation of IST (P = 0.32). Death from chronic GVHD was less common in the day 4 and day 5 cohorts compared
with the 2-day and historical cohorts, though this did not reach statistical significance.
Conclusions
The authors’ preliminary results demonstrated that collection of allogeneic matched
sibling donor PBSCs on day 4 of G-CSF was feasible, reduced donor exposure to growth
factor and was associated with an initial cost savings. Importantly, the authors now
demonstrate that transplantation of day 4 mobilized PBSCs is not associated with any
adverse outcomes post-HCT, including late effects such as chronic GVHD. Further investigation
of donor G-CSF collection algorithms is merited in other HCT settings, including unrelated
and mismatched related donors.
Key Words
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Article info
Publication history
Published online: January 21, 2023
Accepted:
November 15,
2022
Received:
September 20,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.
