The impact of granulocyte colony stimulating factor at content of donor lymphocytes collected for cellular immunotherapy

Abstract 

Background and objectives: Donor lymphocyte infusions (DLI) have become widely used for prevention or treatment of relapse after allogeneic hematopoietic stem cell transplantation. Increasing use of reduced intensity conditioning regimens (RICR) and subsequent application of DLI forced the hemapheresis centers to collect donor lymphocytes in certain quantity and quality. The place of growth factors especially granulocyte colony stimulating factor (rhG-CSF, filgrastim) in allogeneic hemapoietic stem cell (HSC) collection is established, but there is no consensus about the role of rhG-CSF. We aimed to clarify the dose effect of rhG-CSF on lymphocyte subpopulations (CD3+, CD3+4+, CD3+8+, CD19+, CD3−16+56+) cells and CD34+ HSC.

Donors and methods: Major indications for DLI (mean volume: 180±52 ml) were for relapse or transplants using RICR mainly in patients with acute leukemia (n=20) or chronic myeloid leukemia (n=15). In four years we performed 40 lymphocyte apheresis (LA) on 30 healthy (med. age 28, M/F 21/9) donors using continuous flow cell separators by processing 2–2.5 times of their total blood volume (TBV). The apheresis data is divided into three groups according to rhG-CSF dose used for priming. Donors in Group I (n=18), Group II (n=9) and Group III (n=13) received no rhG-CSF (steady state), rhG-CSF 5 μg/kg/dsc×5 days and rhG-CSF 10 μg/kg/dsc×5 days, respectively. There was no difference within groups concerning TBV processed and recipient body weight.

Results: A total of 11,565 ml (±3700) of blood was processed in 216 min (±36.5) at an inlet of 56.8 ml/min (±10.6) using 999 ml (±307) ACD. The CD34+ HSC increased with increasing rhG-CSF dose as expected. Median CD3+ lymphocyte yield per recipient body weight in Group I, II and III were 0.9×10e8/kg (range: 0.1–2.1), 2.9×10e8/kg (range: 1.6–4.3) and 2.1×10e8/kg (range: 0.6–6.9), respectively. The primed donors T lymphocyte yield was 2–3-fold more in comparison to Group I. This gain was most significant between Group I and III in terms of mean CD3+ (1.09×10e8/kg vs 2.41×10e8/kg, p=0.02), CD3+4+ (0.64×10e8/kg vs 1.44×10e8/kg, p=0.02) and CD3+8+ (0.42×10e8/kg vs 0.89×10e8/kg, p=0.03) cells, respectively.

Conclusion: Though the yield of lymphocyte subsets in G-CSF primed donors exceeds the non-primed donors, the target range of 1×10e7–1×10e8/kg CD3+ lymphocytes could be achieved in the majority of the apheresis procedures without rhG-CSF priming. The yield of T and B lymphocyte subsets are increased by G-CSF stimulation but not on a logarithmic scale, which did not correlate into a clinical relevance.

Keywords:  Donor lymphocyte infusion (DLI), G-CSF (filgrastim), CD34 positive cells, CD3 positive cells, Lymphocyte apheresis