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Clinical Applications of CD34⁺ Peripheral Blood Progenitor Cells (PBPC)

Department of Hematology, Oncology, Rheumatology and Immunology, Medical Center II, Eberhard-Karls-University, Tübingen, Germany

Key Words. CD34⁺ • Selection technologies • Autologous • Allogeneic • Transplantation

Correspondence: Wolfram Brugger, M.D., Department of Medicine, Otfried-Müller-Str. 10,72076 Tübingen, Germany. Telephone: 49-7071-2983698; Fax: 49-7071-295591; e-mail:wolfram.brugger{at}med.uni-tuebingen.de

Recently, a number of devices have been developed for the positive selection of CD34⁺ peripheral blood progenitor cells (PBPC) for clinical use in autologous or allogeneic transplantation. The rationale for CD34⁺ selection is based on clinical studies showing a two- to five-log reduction of contaminating tumor cells in patients with breast cancer, multiple myeloma and low-grade lymphoma. In addition, a three- to five-log reduction of T cells can be obtained by CD34⁺ selection in both autologous grafts for patients with autoimmune disease resistant to conventional therapy and allogeneic grafts to reduce the incidence and severity of acute graft-versus-host disease.

Transplantation of positively selected autologous CD34⁺ PBPC results in a rapid and stable neutrophil and platelet engraftment in patients who received an infused dose of at least 2.0 x 10⁶ CD34⁺ cells/kg. Results from randomized trials suggest that time to engraftment is not different compared to unmanipulated PBPC autografts. However, close monitoring for infectious complications (e.g., cytomegalovirus disease) is required. Allogeneic CD34⁺ PBPC have also been successfully transplanted and, using novel technologies, megadoses of purified CD34⁺ PBPC can be obtained and used to overcome histocompatibility differences betweeen allogeneic donor and patient resulting in stable engraftment, even in a haploidentical setting. Additional randomized phase III trials are required to determine whether tumor cell purging or lymphocyte depletion by CD34⁺ cell selection will have a significant impact on progression-free and overall survival in both autologous and allogeneic transplantation.

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