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Purpose <p>Allogeneic hematopoietic stem cell transplantation remains a curative option for acute leukemia. While an adequate CD34<sup>+</sup> cell dose is essential for engraftment, the optimal upper threshold in haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) remains unclear.</p> Methods <p>We retrospectively analyzed 81 patients with acute leukemia who underwent haplo-PBSCT with reduced-intensity conditioning between 2010 and 2020. Patients were stratified by CD34<sup>+</sup> cell dose (&lt; 8 × 10<sup>6</sup>/kg vs. ≥ 8 × 10<sup>6</sup>/kg). Clinical outcomes, including overall survival (OS), non-relapse mortality (NRM), graft failure, and graft-versus-host disease (GVHD) incidence, were compared.</p> Results <p>A higher CD34<sup>+</sup> cell dose was associated with inferior OS (<i>P</i> = 0.022) and increased NRM (<i>P</i> = 0.002), despite similar rates of graft failure and acute GVHD. Chronic GVHD was more frequent in the higher dose group, though the difference was not statistically significant. Multivariate Cox analysis confirmed a high CD34<sup>+</sup> cell dose as an independent predictor of poor OS (HR 2.054, <i>P</i> = 0.031).</p> Conclusion <p>These findings suggest that excessively high doses may adversely affect survival by increasing transplant-related toxicity. Graft cell dose should be carefully balanced to optimize outcomes in haplo-PBSCT.</p>

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Impact of CD34+ cell dose on outcomes of haploidentical peripheral blood stem cell transplantation in acute leukemia

  • 期刊论文

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  • 发表日期：

    2025年8月7日

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  • Haerim Chung,
  • Hye Won Kook,
  • Hyunsoo Cho,
  • Ji Eun Jang,
  • June-Won Cheong

摘要

Purpose

Allogeneic hematopoietic stem cell transplantation remains a curative option for acute leukemia. While an adequate CD34+ cell dose is essential for engraftment, the optimal upper threshold in haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) remains unclear.

Methods

We retrospectively analyzed 81 patients with acute leukemia who underwent haplo-PBSCT with reduced-intensity conditioning between 2010 and 2020. Patients were stratified by CD34+ cell dose (< 8 × 106/kg vs. ≥ 8 × 106/kg). Clinical outcomes, including overall survival (OS), non-relapse mortality (NRM), graft failure, and graft-versus-host disease (GVHD) incidence, were compared.

Results

A higher CD34+ cell dose was associated with inferior OS (P = 0.022) and increased NRM (P = 0.002), despite similar rates of graft failure and acute GVHD. Chronic GVHD was more frequent in the higher dose group, though the difference was not statistically significant. Multivariate Cox analysis confirmed a high CD34+ cell dose as an independent predictor of poor OS (HR 2.054, P = 0.031).

Conclusion

These findings suggest that excessively high doses may adversely affect survival by increasing transplant-related toxicity. Graft cell dose should be carefully balanced to optimize outcomes in haplo-PBSCT.