Higher CD 34 Cell Doses Reduce Non Relapse Mortality (NRM) and Do Not Increase the Incidence of Graft Versus Host Disease (GVHD) Following Unrelated Donor Blood Stem Cell Transplantation (SCT).
Bibliographic record
Abstract
Background: Higher CD34 cell doses have been shown to increase the incidence of acute (Przepiorka D et al, 1999) and extensive chronic GVHD (Zaucha et al, 2001) following HLA-matched sibling SCT. Less is known about the influence of CD 34 cell dose in the unrelated SCT setting. Methods: A retrospective review was performed involving 81 consecutive adult patients (pts) who underwent unrelated donor G-CSF mobilised blood SCT in Vancouver between June 2000 and October 2006. NRM, relapse risk (RR) and overall survival (OAS) estimates were determined using a Kaplan-Meier technique and univariate and multivariate analyses were done to identify factors predictive of GVHD and outcome, with particular focus on cell dose administered. Characteristics: There were 46 male and 35 female pts with a median age of 44 (range 17–58) years. Diagnoses included acute leukemia (39 pts), chronic leukemia (14 pts), lymphoma (15 pts) and other (13 pts). Conditioning was TBI-based in 80/81 pts and GVHD prophylaxis was with continuous infusion Cyclosporine and short-course Methotrexate (MTX) (15mg/m2 d +1 and 10mg/m2 d+3, d+6 and d+11). Fifty of 81 pts received >80% of the planned MTX dose. Forty three pts received SCT from a 10/10 high-resolution HLA-matched donor, 25 pts received a 1-antigen mismatched SCT, 12 pts received a 2-antigen mismatched SCT and 1 pt a 3-antigen mismatched SCT. The donor was male for 68 pts and female for 13 pts. Median CD 34 cell dose was 7.75x106 (range−9.46x104–33.6x106)/kg. Results: The estimated 3-year NRM, RR and OAS were 39% (95%CI 25%–50%), 30% (95%CI 17%–41%) and 43% (95%CI 31%–58%), respectively. In multivariate analysis, CD 34 cell dose >7.75x106/kg was associated with faster neutrophil engraftment, p<0.001 and reduced NRM (28% vs. 49%, p=.019), but did not influence the incidence of either acute or chronic GVHD or OAS. Multivariate analysis showed that the most important predictor of grade 3–4 acute GVHD (49% vs. 22%, p=.005), NRM (65 vs. 30%, p=.006), and OAS (24% vs. 50%) was administration of >80% of the planned MTX dose. Although having a female donor predicted for an increase in NRM (p=.03), it also was associated with a decrease in RR (0/13 pts) and did not affect OAS. Conclusion: A high CD34 cell dose in unrelated donor blood SCT is desirable in that it does not adversely influence the incidence of GVHD and is associated with faster neutrophil engraftment and a reduction in NRM. Delivery of at least 80% of the planned short-course MTX GVHD prophylaxis continues to be critical in producing a favourable outcome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".