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Absence of influence of peripheral blood CD34+ and CD3+ graft cell counts on outcomes after reduced-intensity conditioning transplantation using post-transplant cyclophosphamide

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Abstract

The influence of peripheral blood stem cell (PBSC) graft cell contents after transplant with post-transplant cyclophosphamide (PTCY) remains unclear. Here, we retrospectively report on a cohort of 77 adults who received a Baltimore-based reduced-intensity conditioning regimen either with fludarabine (n = 40) or clofarabine (n = 37) and PTCY. With a median follow-up of 29.2 months, [2-]year overall (OS), disease-free (DFS), and GVHD/relapse-free survival (GRFS) rates were 62.8%, 51%, and 36.7%, respectively. The incidence of grades [2–]4 acute GVHD was significantly higher in patients transplanted with a haplodonor (n = 56), at 57.1% vs 19% (p = 0.006). PBSC graft cell contents (CD45+, CD34+, and CD3+ cells) had no impact on any outcome. Considering immune reconstitution until 1 year, only monocytes were above the normal range (as early as day + 30) during the first year post-transplant. In multivariate analysis, an older donor (> 45 years) and a high/very high disease risk index were independently associated with lower OS. A higher monocyte count (> median) at day + 90 was also associated with better OS, DFS, and GRFS. Donor/recipient CMV status matching was independently associated with GRFS. In conclusion, our data support the fact that there is no need to manipulate the graft before infusion in the particular context of PBSC/PTCY Baltimore-based allotransplant.

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Acknowledgments

We want to thank all the nurses for their dedicated patient care.

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Authors and Affiliations

  1. Hematology Department, CHU Hotel-Dieu, Nantes, France

    Alice Garnier, Thierry Guillaume, Pierre Peterlin, Amandine Le Bourgeois, Béatrice Mahé, Viviane Dubruille, Nicolas Blin, Cyrille Touzeau, Thomas Gastinne, Anne Lok, Benoit Tessoulin, Steven Le Gouill, Philippe Moreau & Patrice Chevallier

  2. Cellular Engineering Unit, EFS Pays de la Loire, Nantes, France

    Alix Duquesne

  3. Hematology/Biology, CHU Hotel-Dieu, Nantes, France

    Marion Eveillard & Marie C. Béné

  4. Service d’Hématologie Clinique, CHU Hotel-Dieu, Place A. Ricordeau, 44093, Nantes Cedex, France

    Patrice Chevallier

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  1. Alice Garnier
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  2. Thierry Guillaume
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Contributions

AG and PC designed, performed, and coordinated the research; analyzed and interpreted the data; and wrote the manuscript. MCB performed statistical analyses, provided the figures, and helped writing the manuscript. TG, PP, ALB, AD, ME, BM, VD, NB, CT, TG, AL, AB, SLG, and PM contributed with data collection and commented on the manuscript.

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Correspondence to Patrice Chevallier.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Garnier, A., Guillaume, T., Peterlin, P. et al. Absence of influence of peripheral blood CD34+ and CD3+ graft cell counts on outcomes after reduced-intensity conditioning transplantation using post-transplant cyclophosphamide. Ann Hematol 99, 1341–1350 (2020). https://doi.org/10.1007/s00277-020-04031-4

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