Journal of Clinical Oncology, Vol 18, Issue 6
(March), 2000: 1360-1377
© 2000 American Society for Clinical Oncology
Therapeutic Relevance of CD34 Cell Dose in Blood Cell Transplantation for Cancer Therapy
By Salvatore Siena,
Roberta Schiavo,
Paolo Pedrazzoli,
Carmelo Carlo-Stella
From the Falck Division of Medical Oncology, Department of Hematology and Oncology, Ospedale Niguarda Ca’ Granda, Milan, and Cattedra di Ematologia, Università di Parma, Parma, Italy.
Address reprint requests to Salvatore Siena, MD, The Falck Division of Medical Oncology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, I-20162 Milan, Italy; email salvatore.siena{at}tin.it
ABSTRACT
PURPOSE: To review recent advances in peripheral-blood progenitor-cell (PBPC) transplantation in order to define the optimal cell dose required for autologous and allogeneic transplantation.
MATERIALS AND METHODS: A search of MEDLINE was conducted to identify relevant publications. Their bibliographies were also used to identify further articles and abstracts for critical review.
RESULTS: The CD34+ cell content of a graft is regarded as an accurate predictor of engraftment success. Postchemotherapy autologous PBPC transplantation with  5 x 106 CD34+ cells/kg body weight leads to more rapid engraftment than does transplantation of lower cell doses. Further increases in transplant cell dose further accelerate platelet but not neutrophil engraftment. Evidence that long-term hematopoietic recovery may be more accurately predicted by the subpopulation of primitive progenitors transplanted suggests that the content of CD34+CD33- and long-term culture-initiating cells in cell collection samples may be important for predicting successful engraftment, particularly in patients with poor mobilization. Allogeneic transplantation has been limited by concerns regarding graft-versus-host disease and the use of hematopoietic growth factors in donors. The risk of graft rejection and engraftment failure after HLA-mismatched allogeneic transplantation may be overcome by intensive chemoradiotherapy and the infusion of large numbers of T cell–depleted hematopoietic stem cells.
CONCLUSION: An optimal cell dose of 8 x 106 CD34+ cells/kg seems to be recommended for autologous PBPC transplantation. This dose facilitates the administration of scheduled chemotherapy on time and reduces the demand for other supportive therapies. A combination of growth factors may enable patients with poor mobilization to achieve a collection sufficient to allow transplantation. The optimum PBPC dose for allogeneic transplantation remains to be defined.
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