ASBMT Risk Group and CD 34+ Dose Predicted for the Development of aGVHD in Allogeneic MRD Transplants When the Donors Who Received a Combined Mobilization and In Vivo TCD Regimen Using rhg-CFS and Dexamethasone.

We looked at factors affecting the development of acute and chronic GVHD in a cohort of 118 patients who underwent allogeneic matched sibling transplantation between 09/1998 to 05/2006 at the UAB BMT program. Donors were mobilized with rhg-CSF (10–16mcg/kg/day x4) and received dexamethasone 10mg/m2/day x3 days to effect in vivo T cell depletion (TCD). Total CD3 and CD34 cell dose were divided in to 4 quartiles (See table below). We then analyzed the influence of CD3+ and CD34+ dose quartiles on aGVHD, cGVHD, engraftment, TRM and relapse. (see table) Acute GVHD: Univariate Logistic regression indicated that the development of aGVHD is negatively associated with quartiles (q25–q50) interval of CD3 dose (p=0.0418). However this relationship was not independent of risk factor and CD34 dose. After using Multivariable Logistic regression analysis with adjustments for age, race and sex, we found that ASBMT risk factor and CD34 quartiles dose are strong predictors of aGVHD: patients who had high risk are about three times more likely to have aGVHD (OR=2.829, 95% CI 1.142–7.020, p=0.0250). The higher the CD34 dose also predisposed to higher incidence of aGVHD (p=0.0432). Median Survival: Patients who received the CD3 (P=0.00141) and CD34 (P=0.0270) in the q25–q50 quartile did better with improved median survival. Relapse and CD 3 quartiles: Using the - 2 log (LR) test shows the relapse free interval was longer if the CD3 dose is between q25 and q50 (p=0.0058); there was no relation between CD34 and relapse. TRM: Not associated with CD3 or CD 34 dose. WBC engraftment: Multivariable analysis indicated that the relationship is mainly an age effect. After adjusted for risk factor, GVHD status, CD3 or CD34 dose, the engraftment day is still significantly related to age at BMT (p=0.0252). No associations are observed for the relationship between engraftment day and GVHD risk. cGVHD: Neither CD34 dose (p=0.5339) nor CD3 (p=0.4209) dose were statistically associated with incidence and severity of cGVHD. To summarize, higher CD34 dose and higher risk ASBMT category predicted for higher incidence of aGVHD; neither CD3 nor CD 34 dose predicted for the development of cGVHD. Age was the single most important predictor of WBC engraftment.