Single Center Report on the Variety of Clinical Applications of Allogeneic Peripheral Blood Stem Cell Transplantation / 대한혈액학회지

ABSTRACT

BACKGROUND: It is apparent that more stem cells can be harvested by mobilization treatment with recombinant human G-CSF and/or GM-CSF from normal healthy donors in allogeneic peripheral blood stem cell transplantation (allo-PBSCT) compared to allogeneic bone marrow transplantation (allo-BMT). It is also known to be more effective in inducing the graft-vs-tumor effects than allogeneic BMT because of higher T cell content. METHODS: A variety of clinical applications with allo-PBSCT was done for patients with he matological malignancies with a high risk of relapse in single transplantation center. We reported the preliminary results on trial of allo-PBSCT followed by planned prophylactic G- and/or GM-CSF primed donor lymphocyte infusion additionally reserved at harvest in hematological malignancies with a high risk of relapse and also presented the successful trial of non-myeloablative transplantation for old aged AML patient in 4th complete remission and cases with 2nd transplantation with allo-PBSCs. RESULTS: Seventeen patients with hematological malignancies with a high risk of relapse were enrolled in trial of allo-PBSCT followed by prophylactic donor lymphocyte infusion. All patients received allogeneic PBSCT from HLA- matched sibling donors. Seven out of 17 patients received additional PBSCs with a median number of CD3+ cells of 5.0x107/kg (range, 3.0 to 9.9x107/kg), between day 41 and day 120. Four surviving patients (4/7) were free of disease when last assessed (median follow-up duration, 538 days), but were suffering from chronic GVHD (1 limited and 3 extensive). A 56 year old acute myeloid leukemia patient in the 4th complete remission was successfully treated with allo-PBSCT with non-myeloablative conditioning regimen. One of 2 patients who received second transplantation with allo-PBSCT has shown a long term disease free survival. CONCLUSION: A merit of allo-PBSCT would allow us to design a variety of clinical applications. Allo-PBSCT might be preferable in special clinical setting such as non-myeloablative transplantation, second transplantation, or the situation in need of the strong GVL effect. And also CSF-primed PBSCs can be used for the purpose of donor lymphocyte infusion.