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M.M. Cuadrado et al.
an CD34+ cell dose/kg recipient weight was 3.2x106/kg (range, 0.47-14.2) and the median CD3+ dose was 4.3x103/kg (range, 0-13). At the time of CD34+-selected infusion, the median neutrophil count was 0.7x109/L (range, 0.01-10), the median platelet count was 17x109/L (range, 5-296) and the median hemoglobin concentration was 8.7 g/dL (range, 5.3 to 12.5). Of the 62 treated patients, 47 (76%) showed a hematologic improvement with complete (n=39) or partial recovery (n=8). Evidence of recovery was observed in 23 patients within 30 days; of these, 20 patients achieved complete recovery and three patients had partial recovery. Hematologic improvement after 30 days was observed in 23 patients; of these 18 patients achieved complete recovery and five patients had partial recovery. In patients showing hematologic improvement with complete or partial recovery, the medi- an number of days required for the recovery of neu- trophils was 29 days (range, 6-1,182), that for the recovery of platelets was 18 days (range, 5-600) and that for recov- ery of hemoglobin was 25 days (range, 6-511). The time range for recovery of neutrophils was especially prolonged and reflected the requirement for responding patients to be independent of any growth factor support. There were no differences in recovery times for patients showing complete versus partial recovery (Figure 1). The probability of complete or partial recovery was also analyzed accord- ing to the number of lineages affected and although there
were no differences in total rates of recovery, the propor- tion of patients achieving complete recovery was greater if poor graft function affected one or two lineages versus all three lineages (16/16 [100%] versus 23/31 [74%]; P=0.04). All patients who demonstrated complete or partial recov- ery after CD34+-selected infusion maintained their recov- ery throughout the follow-up period.
Factors associated with hematologic improvement
In univariate analyses to determine factors predictive of recovery, we found that shared donor-recipient CMV seronegative status, donor-recipient sex matching, absence of active infection at the time of CD34+-selected infusion and low EBMT Risk Score were associated with recovery (Table 2A, B). Patients sharing a CMV seronega- tive status with the donor achieved complete or partial recovery more frequently than any other recipient-donor serostatus combination (21/23 [91%] versus 26/39 [68%]; P=0.03). Sex matching between the donor and recipient was also associated with a better rate of recovery than mismatched combinations (28/31 [90%] versus 19/31 [61%]; P=0.008); female recipients of transplants from male donors had the worst rates of recovery (8/15 [53%] versus 39/47 [83%]; P=0.02). Patients without active infec- tion during CD34+-selected infusion had higher rates of recovery than the patients with infection (33/36 [92%] ver- sus 12/24 [50%]; P<0.001; data missing for 2 patients).
C
AB
Figure 1. Time to recovery after CD34+-selected stem cell infusion. (A) Time to recovery (days) for all patients. (B) Time to recovery (days) for patients with com- plete recovery and partial recovery. (C) Time to recovery (days) according to cell lineages. CR: complete recovery; PR: partial recovery; Hb: hemoglobin.
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haematologica | 2020; 105(11)