•Donor apheresis volume ≥15 L is associated with better survival after allogeneic hematopoietic stem cell transplantation.•The survival advantage is driven by a decrease in relapse risk.•Higher ...apheresis volumes are associated with higher T cell dose but not with higher CD34+ cell dose.
Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced-intensity conditioning (RIC) offers a curative option for patients with hematologic malignancies who are unable to undergo myeloablative conditioning, but its success is limited by high rates of relapse. Several studies have suggested a role for T cell doses in peripheral blood stem cell grafts in RIC HSCT. Because T cell dose is typically not known until after the collection, and apheresis blood volume is easily modifiable, we hypothesized that higher donor apheresis blood volumes would improve transplantation outcomes through an effect on graft composition. Thus, we analyzed the relationships between apheresis volume, graft composition, and transplantation outcomes in 142 consecutive patients undergoing unrelated donor allogeneic RIC HSCT. We found that apheresis volume ≥15 L was associated with a significantly decreased risk of relapse (adjusted hazard ratio aHR, .48; 95% confidence interval CI, .28 to .84; P = .01) and improved relapse-free survival (aHR, .56; 95% CI, .35 to .89; P = .02) and overall survival (aHR, .55; 95% CI, .34 to .91; P = .02). A high apheresis volume was not associated with increased rates of acute or chronic graft-versus-host disease. These results demonstrate that an apheresis volume of at least 15 L is independently predictive of improved transplantation outcomes after RIC allogeneic HSCT.
Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced intensity conditioning (RIC) offers a curative option for patients with hematologic malignancies who are unable to undergo ...myeloablative conditioning, but its success is limited by high rates of relapse. Several studies have suggested a role for T-cell doses in peripheral blood stem-cell grafts in RIC HSCT. Since T-cell dose is typically not known until after the collection, and apheresis blood volume is easily modifiable, we hypothesized that higher donor apheresis blood volumes would improve transplant outcomes through an effect on graft composition. We therefore analyzed the relationships between apheresis volume, graft composition and transplant outcomes in 142 consecutive patients undergoing unrelated donor allogeneic RIC HSCT.
We found that apheresis volume 15L or greater was associated with a significantly decreased risk of relapse (adjusted hazard ratio (aHR) 0.48, 95% CI 0.28–0.84), p=0.01) and improved relapse-free survival (aHR 0.56, 95% CI 0.35–0.89, p=0.02) and overall survival (aHR 0.55, 95% CI 0.34–0.91, p=0.02). A high apheresis volume was not associated with increased rates of acute or chronic GVHD. These results demonstrate that an apheresis volume of at least 15L is independently predictive of improved transplant outcomes after RIC allogeneic HSCT.
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