TY - JOUR
T1 - Disease stage stratified effects of cell dose in unrelated BMT for hematological malignancies
T2 - A report from Japan marrow donor program
AU - Inamoto, Y.
AU - Miyamura, K.
AU - Okamoto, S.
AU - Akiyama, H.
AU - Iida, H.
AU - Eto, T.
AU - Morishima, Y.
AU - Kawa, K.
AU - Kikuchi, A.
AU - Nagatoshi, Y.
AU - Tanaka, J.
AU - Ashida, T.
AU - Hirokawa, M.
AU - Tsuchida, M.
AU - Mori, S.
N1 - Funding Information:
Acknowledgements This study was supported by the Deutsche Forschungsgemeinschaft, SFB 307-A10. We want to thank Dr. Straumann and Dr. B. J. M. Hess for valuable comments on the manuscripts, and we are especially grateful to Dr. D. Tweed for the extensive discussions as well as for the permission to reanalyze data from his earlier study.
PY - 2011/9
Y1 - 2011/9
N2 - Cell dose is one of the major factors that can be manipulated in unrelated BMT. However, regarding disease-stage-stratified effects of cell dose, data are limited. We analyzed the registry data from 3559 patients with acute leukemia, CML and myelodysplastic syndrome who received T-cell replete unrelated BMT through the Japan Marrow Donor Program. Adjusted effects of cell dose were evaluated for various outcomes separately according to disease stages and children or adults. Acute GVHD and nonrelapse mortality were not affected by cell dose. Among children, a cell dose lower than 3.0 × 10 8/kg was associated with lower engraftment rates in advanced-stage diseases. Among adults, a cell dose of 3.4 × 10 8/kg or higher was associated with lower relapse rates and better survival rates only in early-stage diseases, whereas cell dose below 2.3 × 10 8/kg was associated with lower engraftment rates in advanced-stage diseases. In conclusion, effects of cell dose may differ among disease stages. A cell dose of 3.4 × 10 8/kg or higher is recommended only for adults with early-stage diseases. With the number of patients available for analysis in this study, we could not show any significant benefits associated with 4.6 × 10 8/kg or higher in children.
AB - Cell dose is one of the major factors that can be manipulated in unrelated BMT. However, regarding disease-stage-stratified effects of cell dose, data are limited. We analyzed the registry data from 3559 patients with acute leukemia, CML and myelodysplastic syndrome who received T-cell replete unrelated BMT through the Japan Marrow Donor Program. Adjusted effects of cell dose were evaluated for various outcomes separately according to disease stages and children or adults. Acute GVHD and nonrelapse mortality were not affected by cell dose. Among children, a cell dose lower than 3.0 × 10 8/kg was associated with lower engraftment rates in advanced-stage diseases. Among adults, a cell dose of 3.4 × 10 8/kg or higher was associated with lower relapse rates and better survival rates only in early-stage diseases, whereas cell dose below 2.3 × 10 8/kg was associated with lower engraftment rates in advanced-stage diseases. In conclusion, effects of cell dose may differ among disease stages. A cell dose of 3.4 × 10 8/kg or higher is recommended only for adults with early-stage diseases. With the number of patients available for analysis in this study, we could not show any significant benefits associated with 4.6 × 10 8/kg or higher in children.
KW - allogeneic
KW - cell dose
KW - disease stage
KW - unrelated
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U2 - 10.1038/bmt.2010.281
DO - 10.1038/bmt.2010.281
M3 - Article
C2 - 21057551
AN - SCOPUS:80052445981
SN - 0268-3369
VL - 46
SP - 1192
EP - 1202
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 9
ER -