The role of accessory cells in allogeneic peripheral blood stem cell transplantation.

Granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood mononuclear cells (G-PBMC) have been used increasingly to reconstitute hematopoiesis after myeloablative therapy in allogeneic transplantation. Compared with conventional bone marrow, faster engraftment is consistently observed with G-PBMC, with differences more pronounced in platelet than in neutrophil recovery. G-PBMC contain not only severalfold more CD34+ cells than bone marrow but also, on average, 50-fold more monocytes, which may stimulate stromal cell function and facilitate engraftment. Although G-PBMC also contain 10-fold more T cells, the incidence and severity of acute graft-vs.-host disease (GVHD) is no higher than that observed in allogeneic bone marrow transplantation. Hypothetically, these clinical observations can be explained by the direct effect of G-CSF on T cell function as demonstrated by polarization of T cells expressing the T helper type 2 (Th 2) cytokine interleukin (IL)-4 in the murine model. Alternatively, G-PBMC may contain cells that actively suppress donor T cell responsiveness. Recent reports indicate that the large number of CD14+ monocytes in G-PBMC can suppress donor T cell proliferation in vitro. This effect may be attributable to both the increased ratio of CD14+:CD3+ cells in G-PBMC and the evidence that CD14+ cells in G-PBMC have decreased expression of both B7.2 and HLA-DR. There is some indication that natural killer (NK) cell number and function may be augmented in G-PBMC, which could have a favorable impact on the graft-vs.-leukemia (GVL) effect. Therefore, both the CD34+ and accessory cell content of G-PBMC may be important in early engraftment by controlling acute GVHD and facilitating GVL.