Muhammad Umair Mushtaq: Graft Cell Dose in Haploidentical PBSC with Post-Transplant Cyclophosphamide
Muhammad Umair Mushtaq, Associate Professor of Medicine at the University of Kansas Medical Center, shared a paper he and his colleagues authored on LinkedIn:
“Mushtaq MU, et al. Impact of Graft Cell Dose on Outcomes after Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplant Cyclophosphamide-Based GVHD Prophylaxis. Transplantation and Cellular Therapy. 2025; 31(2): S301”
Authors: Muhammad Umair Mushtaq et al.
This retrospective study analyzed data from 266 patients who underwent haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) between 2013 and 2018, using the publicly available Center for International Blood and Marrow Transplant dataset (P-5737, Ustun et al.).
Patients were categorized based on their graft cell dose into three groups: low dose (LD, 0–2 million CD34+ cells/kg, 8%, n=22), intermediate dose (ID, >2–5 million CD34+ cells/kg, 31%, n=82), and high dose (HD, >5 million CD34+ cells/kg, 61%, n=162).
To identify factors influencing key clinical outcomes, Cox proportional hazard regression analyses were conducted, with results presented as hazard ratios (HR) and 95% confidence intervals (CI). Statistical analyses were performed using Stata version 18, with a significance threshold set at p<0.05.
Survival Outcomes by Graft Cell Dose
Overall Survival (OS): Median OS was 2.85 years overall.
– Low Dose (LD): 0.53 years (95% CI 0.30–0.87)
– Intermediate Dose (ID): 2.46 years (95% CI 0.63–not reached)
– High Dose (HD): 4.48 years (95% CI 1.94–not reached)
Disease-Free Survival (DFS): Median DFS was 0.95 years overall.
– LD: 0.37 years (95% CI 0.20–0.77)
– ID: 1.21 years (95% CI 0.63–not reached)
– HD: 1.05 years (95% CI 0.61–2.44)
GVHD-Free Relapse-Free Survival (GRFS): Median GRFS was 0.25 years overall.
– LD: 0.20 years
– ID: 0.24 years
– HD: 0.26 years
Survival outcomes improved with higher CD34+ graft cell doses, with the highest dose group (HD) showing the longest OS and DFS. However, GRFS remained low across all groups.
The incidence of relapse, grade II-IV acute GVHD, and chronic GVHD was similar across all groups. However, multivariate regression analysis showed:
Graft cell dose of 2–5 million CD34+ cells/kg
Improved survival: OS (HR 0.34, 95% CI 0.18–0.63, p=0.001), DFS (HR 0.35, 95% CI 0.19–0.64, p=0.001)
Lower relapse risk: HR 0.17, 95% CI 0.07–0.39, p<0.001
No significant impact on: GRFS, NRM, or GVHD incidence
Graft cell dose >5 million CD34+ cells/kg
Further improved survival: OS (HR 0.31, 95% CI 0.17–0.55, p<0.001), DFS (HR 0.38, 95% CI 0.22–0.65, p<0.001)
Better GRFS: HR 0.57, 95% CI 0.34–0.96, p=0.033
Lower relapse risk: HR 0.24, 95% CI 0.12–0.51, p<0.001
No significant effect on: NRM or GVHD incidence
A higher CD34+ graft cell dose significantly improves outcomes in haploidentical peripheral blood stem cell transplantation. The data support using more than 2 million CD34+ cells/kg, with the best survival and relapse prevention seen at doses exceeding 5 million CD34+ cells/kg.
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