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Jeung, Kang, Kwon, Kim, Lee, Lee, Kim, Bae, Kim, Lee, Lee, Park, Won, Hong, and Park: Influential Factors for Engraftment in Autologous Peripheral Hematopoietic Stem Cell Transplantation (APBSCT)
Original Article

Korean J Hematol 2007;42(4):301-308.

Published online: 19 January 2007

DOI: https://doi.org/10.5045/kjh.2007.42.4.301

Influential Factors for Engraftment in Autologous Peripheral Hematopoietic Stem Cell Transplantation (APBSCT)

Ki Ju Jeung, Myung Soo Kang, Ki Du Kwon, Kyoung Ha Kim, Jong Chan Lee, Sang Chul Lee1, Hyun Jung Kim1, Sang Byung Bae1, Chan Kyu Kim1, Nam Su Lee1, Kyu Taeg Lee1, Sung Kyu Park1, Jong Ho Won1, Dae Sik Hong1, , Hee Sook Park1

Department of Internal Medicine, Bucheon, Korea

1Division of Hematology and Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea

Correspondence to：Dae Sik Hong, M.D. Division of Hematology and Oncology, Bucheon Hospital, Soonchunhyang University College of Medicine 1174, Jung-dong, Wonmi-gu, Bucheon 420-767, Korea Tel: ＋82-32-621-5184, Fax: ＋82-32-621-5016 E-mail: dshong@schbc.ac.kr

Received 9 May 2007       Revised 22 October 2007       Accepted 30 October 2007

Copyright © 2007 Korean Society of Hematology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Autologous peripheral hematopoietic stem cell transplantation (APBSCT) has been widely used to treat various types of hematological disorders, metabolic diseases and congenital immunodeficiency. Hematopoietic recovery is important because prolonged duration of neutropenia and thrombocytopenia is associated with a higher risk of infection, bleeding and treatment related mortality. Many investigators have studied the factors that affect hematopoietic recovery after stem cell transplantation.

Methods:

We retrospectively investigated the factors influencing hematopoietic engraftment in 112 patients with hematological malignancies and solid tumors who received APBSCT. We evaluated the gender, age, CD34+ cell number, conditioning regimens, and the type of tumor and their association with neutrophil and platelet engraftment.

Results:

Post-transplant neutrophil engraftment (＞500/μL) required a median of 11 days (range 6∼50) and platelet engraftment 12 (range 1∼78) days (＞20,000/μL). The univariate analysis showed that the factors that positively affected hematopoietic recovery were: the type of conditioning regimens such as BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) and BEAC (BCNU, etoposide, cytosine arabinoside, cyclophosphamide) versus BC (busulfan, cyclophosphamide), the CD34+ cell number and the disease diagnosis such as multiple myeloma versus acute myelogenous leukemia. The multivariate analysis showed only the CD34+ cell number (5∼10×106/kg) to be significantly associated with early neutrophil and platelet engraftment (P＜.001).

Conclusion:

These findings suggest that measurement of the CD34+ cell count may be sufficient to predict the time to engraftment after APBSCT.

Keywords: Engraftment, Autologous, Stem cell transplantation

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Fig. 1
Analysis of the correlation between CD34+ cell dose and engraftment in Auto PBSCT illustrate that infused CD34+ cell/kg is significantly correlated with the time to neutrophil and platelet engraftment.
kjh-42-301f1.tif
Fig. 2
Kaplan-Meier cumulative probability curves illustrate CD34+ cell number (＞5.0×106/kg) is significantly associated with neutrophil and platelet engraftment in APBSCT (P＜.001).
kjh-42-301f2.tif
Table 1.
Patient characteristics
Patients (n) 112
Age∗ 47 (12∼67)
Interval to APBSCT (month)∗ 9 (1∼120)
ECOG status 0∼2
Sex (male/female) 44/68
MNC count, ×108/kg∗ 7.48 (1.68∼20.81)
CD34+cell, ×106/kg∗ 5.31 (0.71∼77.1)
G-CSF duration (day)∗ 12 (4∼45)
RBC transfusion, n∗ Platelet transfusion, n∗ 3 (0∼22) 6 (0∼28)
Diagnosis (n) ALL 4  NHL    39
      AML 12  Ovarian cancer    5
      Breast cancer 12  Sarcoma    7
      Germ cell tumor 3  SCLC    2
      MM 26  Others    2
Table 2.
Correlations between progenitor cell dose and hematopoietic engraftment time
Hematopoietic engraftment Progenitor cell dose r P value
Time to ANC＞500/μL MNC/kg -0.167 0.98
11 (6∼50) days      
Time to ANC＞500/μL 11 (6∼50) days CD34+ cells/kg -0.219 0.03∗
Time to platelet＞20,000/μL 12 (1∼78) days MNC/kg -0.153 0.13
Time to platelet＞20,000/μL CD34+ cells/kg -0.278 0.005∗
12 (1∼78) days      

∗Statistical significance test done by Pearson's correlation test P value＜0.05. Abbreviation: ANC, absolute neutrophil count.

Table 3.
Conditioning regimens and hematopoietic engraftment
Conditioning regimens (n) Time to ANC＞500/μL Median day (range) Time to platelet＞20,000/μL Median day (range)
Melphalan (26) 12 (7∼26) 14 (1∼35)
BUCY (16) 10 (6∼14) 11 (4∼78)
BEAM+BEAC (28) 10 (8∼22) 12 (2∼76)
ICE (4) 11 (9∼14) 12 (6∼17)
TMJ (5) 9 (8∼16) 11 (1∼28)
Others (14) 13 (10∼50) 18 (1∼50)
Melphalan/BUCY 12 (7∼26)/10 (6∼14) P=0.021∗ 14 (1∼35)/11 (4∼78) P=0.46
Melphalan/BEAM+BEAC 12 (7∼26)/10 (8∼22) P=0.037∗ 14 (1∼35)/12 (2∼76) P=0.23
BUCY/BEAM+BEAC 10 (6∼14)/10 (8∼22) P=0.317 11 (4∼78)/12 (2∼76) P=0.37

∗Statistical significance test done by log rank test P value＜0.05. Abbreviations: BEAM, BCNU, etoposide, cytosine arabinoside, melphalan; BEAC, BCNU, etoposide, cytosine arabinoside cyclophosphamide; BUCY, busulfan, cyclophosphamide; ICE, ifosphamide, carboplatin, etoposide; TMJ, thiotepa, mitoxan trone, carboplatin.

Table 4.
Diseases and hematopoietic engraftment
Diagnosis (n) Time to ANC＞500/μL Median day (range) Time to platelet＞20,000/μL Median day (range)
ALL (4) 9 (7∼11) 9 (7∼11)
AML (12) 13 (6∼50) 17 (9∼78)
NHL (39) 11 (8∼49) 12 (2∼76)
MM (26) 12 (7∼26) 14 (1∼35)
AML/MM 13 (6∼50)/12 (7∼26) P=0.94 17 (9∼78)/14 (1∼35) P=0.012∗
NHL/MM 11 (8∼49)/12 (7∼26) P=0.32 12 (2∼76)/14 (1∼35) P=0.76
AML/NHL 13 (6∼50)/11 (8∼49) P=0.62 17 (9∼78)/12 (2∼76) P=0.06

∗Statistical significance test done by log rank test P value＜0.05. Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myelogenous leukemia; MM, multiple myeloma; NHL, non-Hodgkin's lymphoma.

Table 5.
Other influential factors for hematopoietic engraftment
  Time to ANC ＞500/μL Time to platelet ＞20,000/μL
Median day (range) P Median day (range) P
Age (40＞/≤40) 12 (7∼50) 11 (6∼49) 0.583 13 (1∼78) 14 (1∼76) 0.493
Sex (female/male) 11 (6∼49) 11 (7∼40) 0.543 14 (1∼78) 13 (1∼56) 0.994
Interval to ABPSCT (1 year＞/≤1) 11 (7∼50) 13 (9∼49) 0.258 14 (1∼78) 15 (1∼76) 0.322
Hematologic/solid tumor 11 (6∼50) 11 (8∼48) 0.346 12 (1∼78) 12 (1∼42) 0.087
CD34+cell 5＜/5∼10×106/kg 13 (6∼50) 11 (8∼16) 0.0016 17 (1∼78) 12 (6∼28) 0.001
5∼10×106/kg/10×106/kg 11 (8∼16) 9 (7∼45) 0.906 12 (6∼28) 9 (1∼42) 0.23

∗Statistical significance test done by log rank test P value＜0.05.

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