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Mainardi, Chiara; Ebinger, Martin; Enkel, Sigrid; Feuchtinger, Tobias; Teltschik, Heiko-Manuel; Eyrich, Matthias; Schumm, Michael; Rabsteyn, Armin; Schlegel, Patrick; Seitz, Christian; Schwarze, Carl-Phillip; Müller, Ingo; Greil, Johann; Bader, Peter; Schlegel, Paul-Gerhardt; Martin, David; Holzer, Ursula; Doering, Michaela; Handgretinger, Rupert; Lang, Peter (2018): CD34+ selected stem cell boosts can improve poor graft function after paediatric allogeneic stem cell transplantation. In: British Journal of Haematology, Vol. 180, No. 1: pp. 90-99
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Abstract

Poor graft function (PGF) is a severe complication of haematopoietic stem cell transplantation (HSCT) and administration of donor stem cell boosts (SCBs) represents a therapeutic option. We report 50 paediatric patients with PGF who received 61 boosts with CD34(+) selected peripheral blood stem cells (PBSC) after transplantation from matched unrelated (n=25) or mismatched related (n=25) donors. Within 8weeks, a significant increase in median neutrophil counts (0.6 vs. 1.516x10(9)/l, P<0.05) and a decrease in red blood cell and platelet transfusion requirement (median frequencies 1 and 7 vs. 0, P<0.0001 and <0.001), were observed, and 78.8% of patients resolved one or two of their cytopenias. 36.5% had a complete haematological response. Median lymphocyte counts for CD3(+), CD3(+)CD4(+), CD19(+) and CD56(+) increased 8.3-, 14.2-, 22.- and 1.6-fold. The rate of de novo acute graft-versus-host disease (GvHD) grade I-III was only 6% and resolved completely. No GvHD grade IV or chronic GvHD occurred. Patients who responded to SCB displayed a trend toward better overall survival (OS) (P=0.07). Thus, administration of CD34(+) selected SCBs from alternative donors is safe and effective. Further studies are warranted to clarify the impact on immune reconstitution and survival.