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Tandem Meetings 2023 | Outcomes with CD34-selected stem cell boost for poor graft function and graft failure after alloSCT

Muhammad Umair Mushtaq, MD, University of Kansas Medical Center, Westwood, KS, discusses the results of a retrospective study evaluating the outcomes of patients with poor graft function and graft failure following allogeneic stem cell transplantation (alloSCT) who received a CD34-selected stem cell boost (SCB). The study showed that SCB improves the outcomes of this patient population, and reported that infections were the leading cause of death in these patients. The results from this study suggest that CD34-selected boosts should be given early. This interview took place at the 2023 Transplantation & Cellular Therapy Meetings of ASTCT™ and CIBMTR® held in Orlando, FL.

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Transcript (edited for clarity)

We compared the outcomes of 60 patients. These are all 60 patients who received a CD34-selected stem cell boost for poor graft function and graft failure at University of Kansas in the past 10 years. And so we saw encouraging outcomes. We recently published a meta-analysis supporting the use of a CD34-selected stem cell boost for function and graft failure. Now this is a homogenous single-center experience and we included patients with both primary and secondary graft failure...

We compared the outcomes of 60 patients. These are all 60 patients who received a CD34-selected stem cell boost for poor graft function and graft failure at University of Kansas in the past 10 years. And so we saw encouraging outcomes. We recently published a meta-analysis supporting the use of a CD34-selected stem cell boost for function and graft failure. Now this is a homogenous single-center experience and we included patients with both primary and secondary graft failure. And we included patients with poor graft function who are defined as cytopenias in two or more lineages. As such, neutropenia defined with neutrophil count less than 500 per microliter, platelet count less than 30 per microliter, and hemoglobin less than eight grams per deciliter in the presence of transfusion dependence and growth factor support ongoing for two weeks. And we had patients with poor graft function who have full donor chimerism and patients with graft failure or graft rejection concern where there is a mixed chimerism.

We saw responses across all groups. The complete response, hematologic response was 75%. Overall response rate was 83%. The survival in this group, one-year survival was 41%, median survival was about two years, and most patients died with infections, so 70% infectious death. And so the interventions are delayed usually when patients develop graft failure. The time to delivery of these lifesaving interventions, there is a delay in that. So this data would support utilizing a CD34-selected stem cell boost for this challenging complication after transplant early.

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