J Korean Med Sci.  2002 Aug;17(4):468-474. 10.3346/jkms.2002.17.4.468.

Allogeneic Peripheral Blood Stem Cell Rescue of Late Graft Failure after Bone Marrow Transplantation in Patients with Aplastic Anemia

• Chung IJ
• Lee JJ
• Park MR
• Kook H
• Cho SH
• Hwang TJ
• Kim HJ

• KMID: 1109753
• DOI: http://doi.org/10.3346/jkms.2002.17.4.468

Abstract

We investigated the effect and outcome of allogeneic peripheral blood stem cell (PBSC) rescue for aplastic anemia (AA) patients with graft failure after allogeneic bone marrow transplantation (BMT). Seven (28%) of 25 AA patients who received BMT from HLA-identical sibling donors developed late graft failure at a median of 7 months (range, 2.0-9.3 months) after transplantation. The patients with graft failure were treated with PBSC collected from the original donor after mobilization with granulocyte-colony stimulating factor (G-CSF). The median boost dose of peripheral blood mononuclear cells was 3.1 x 10(8)/kg (range, 1.4-11.9 x 10(8)/kg). Median times to reach an absolute neutrophil count greater than 0.5 x 10(9)/L and a platelet count greater than 50 x 10(9)/L were 7 days (range, 4-14 days) and 9 days (range, 3-41 days), respectively. There was sustained graft function in 6 of 7 patients, with a median follow-up duration of 3.3 yr (range, 1.0-6.2 yr). Grade-I acute graft-versus-host disease (GVHD) occurred in 2 patients, while extensive chronic GVHD developed in 3 patients. This report shows that G-CSF-mobilized allogeneic PBSC rescue is very effective in achieving complete and sustained engraftment in patients with AA after graft failure. However, more efficacious measures to prevent extensive chronic GVHD remain to be developed.

Keyword

Anemia; Aplastic; Bone Marrow Transplantation; Peripheral Blood Stem Cells; Graft vs Host Disease

MeSH Terms

Adolescent
Adult
Anemia, Aplastic/*therapy
*Bone Marrow Transplantation
Child
Child, Preschool
Female
*Graft Survival
Graft vs Host Disease
Granulocyte Colony-Stimulating Factor/administration & dosage/pharmacology
*Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells/drug effects/metabolism
Humans
Infant
Male
Survival Rate
Transplantation, Homologous
Treatment Outcome