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. 2018 Jun;24(6):1203-1208.
doi: 10.1016/j.bbmt.2018.01.037. Epub 2018 Feb 2.

Higher Donor Apheresis Blood Volumes Are Associated with Reduced Relapse Risk and Improved Survival in Reduced-Intensity Allogeneic Transplantations with Unrelated Donors

Lisa M Crisalli  1 , Joanne T Hinkle  1 , Christopher C Walling  1 , Mary Sell  2 , Noelle V Frey  1 , Elizabeth O Hexner  1 , Alison W Loren  1 , Selina M Luger  1 , Edward A Stadtmauer  1 , David L Porter  1 , Ran Reshef  3
Affiliations

Higher Donor Apheresis Blood Volumes Are Associated with Reduced Relapse Risk and Improved Survival in Reduced-Intensity Allogeneic Transplantations with Unrelated Donors

Lisa M Crisalli et al. Biol Blood Marrow Transplant. 2018 Jun.

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced-intensity conditioning (RIC) offers a curative option for patients with hematologic malignancies who are unable to undergo myeloablative conditioning, but its success is limited by high rates of relapse. Several studies have suggested a role for T cell doses in peripheral blood stem cell grafts in RIC HSCT. Because T cell dose is typically not known until after the collection, and apheresis blood volume is easily modifiable, we hypothesized that higher donor apheresis blood volumes would improve transplantation outcomes through an effect on graft composition. Thus, we analyzed the relationships between apheresis volume, graft composition, and transplantation outcomes in 142 consecutive patients undergoing unrelated donor allogeneic RIC HSCT. We found that apheresis volume ≥15 L was associated with a significantly decreased risk of relapse (adjusted hazard ratio [aHR], .48; 95% confidence interval [CI], .28 to .84]; P = .01) and improved relapse-free survival (aHR, .56; 95% CI, .35 to .89; P = .02) and overall survival (aHR, .55; 95% CI, .34 to .91; P = .02). A high apheresis volume was not associated with increased rates of acute or chronic graft-versus-host disease. These results demonstrate that an apheresis volume of at least 15 L is independently predictive of improved transplantation outcomes after RIC allogeneic HSCT.

Keywords: Allogeneic; Apheresis; Reduced-intensity conditioning; Transplantation; Unrelated donor.

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Figures

Figure 1
Figure 1
Distribution of total blood volume processed during stem-cell collection with apheresis.
Figure 2
Figure 2
Associations between donor apheresis blood volume (ABV) processed and cell doses. Plots show Pearson correlations between ABV and (A) CD3+ T-cell dose, (B) CD4+ T-cell dose, (C) CD8+ T-cell dose, (D) CD34+ Dose, and (E) Total nucleated cell (TNC) dose.
Figure 3
Figure 3
Kaplan-Meier and cumulative incidence plots comparing patients who received grafts from donors with apheresis blood volume less than 15 L, or at least 15 L. (A) Relapse, (B) Relapse Free Survival, and (C) Overall Survival
Figure 4
Figure 4
Bone marrow (BM), peripheral blood (PB) and peripheral blood T-cell chimerism (TC) in patients who received grafts from high apheresis volume donors vs. low apheresis blood volume donors. An apheresis blood volume of at least 15L was associated with greater Day 100 chimerism in bone marrow (p=0.007) and in whole blood (p=0.05), but not in the T-cell fraction (p=0.21).
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