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Peripheral Blood Stem Cells for Allogeneic Transplantation: A Review

Department of Adult Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Key Words. Peripheral blood stem cell • CD34⁺ • Allogeneic • Transplantation • Hematologic malignancies • Apheresis

Joseph H. Antin, M.D., Dana-Farber Cancer Institute, 44 Binney St., Boston, Massachusetts 02115, USA. Telephone: 617-632-2525; Fax: 617-632-5175; e-mail: Joseph_Antin{at}dfci.harvard.edu  

Peripheral blood stem cells (PBSCs) have become increasingly popular for use in hematopoietic stem cell transplantation. PBSCs are readily collected by continuous-flow apheresis from patients and healthy donors after the administration of s.c. recombinant colony-stimulating factors with only minimal morbidity and discomfort.

Although the precise identification of PBSCs remains elusive, they can be phenotypically identified as a subset of all circulating CD34⁺ cells. There are important phenotypic and biologic distinctions between PBSCs and bone marrow (BM)-derived progenitor cells. PBSCs express more lineage-specific antigens but are less metabolically active than their BM-derived counterparts.

The use of PBSCs for allogeneic transplantation has been compared to BM in several randomized trials and cohort studies. The use of PBSCs in leukemia, myeloma, non-Hodgkin's lymphoma, and myelodysplasia has resulted in shorter times to neutrophil and platelet engraftment at the expense of increased rates of chronic graft-versus-host disease. The increase in graft-versus-host disease is mainly due to a log-fold increase in donor T cells transferred with the graft. Relapse rates after transplantation may be lower after PBSC transplantation but a convincing survival advantage has not been demonstrated overall. It is possible that a stronger graft-versus-tumor effect may exist with PBSCs when compared with BM although the mechanisms leading to this effect are not clear.

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