Background Many patients requiring allogeneic hematopoietic stem cell transplantation (HSCT) do not have an human loukocyte antigen (HLA) matched donor Alternative donors, such as HLA mismatched family donors, are ass...Background Many patients requiring allogeneic hematopoietic stem cell transplantation (HSCT) do not have an human loukocyte antigen (HLA) matched donor Alternative donors, such as HLA mismatched family donors, are associated with higher rates of graft rejection and acute graft versus host disease (aGVHD) if T cells are not first depleted We developed a new technique for HLA mismatched allogeneic HSCT using G CSF primed bone marrow plus G CSF mobilized peripheral blood stem cells without ex vivo T cell depletion Methods In this study, 58 patients, including 33 with high risk or advanced leukemia, were transplanted with cells from an HLA haploidentical family donor with 1-3 mismatched loci After conditioning, patients received G CSF primed bone marrow grafts that had not been depleted ex vivo of T cells, in combination with G CSF mobilized peripheral blood stem cells, as well as GVHD prophylaxis Result All patients achieved sustained, full donor type engraftment The incidence of grade Ⅱ Ⅳ aGVHD was 37 9%, including 3 patients with grade Ⅲ Ⅳ aGVHD The development of aGVHD was not associated with the extent of HLA disparity Chronic GVHD was observed in 30 of 51 evaluable patients (65 4%) Fourteen patients died among whom 7 died of recurrent disease and 7 of transplant related complications Forty four of the 58 patients survived, and 42 remained disease free at the time of a median follow up of 12 months (3 5 to 39 5 months) The 2 year probabilities of disease free survival were 74 8% and 69 3% for standard and high risk patients, respectively Conclusion We developed a new method to use bone marrow from haploidentical family donors without ex vivo T cell depletion, in combination with G PBSCs, as a source of stem cells even in cases of HLA mismatched transplantation展开更多
文摘Background Many patients requiring allogeneic hematopoietic stem cell transplantation (HSCT) do not have an human loukocyte antigen (HLA) matched donor Alternative donors, such as HLA mismatched family donors, are associated with higher rates of graft rejection and acute graft versus host disease (aGVHD) if T cells are not first depleted We developed a new technique for HLA mismatched allogeneic HSCT using G CSF primed bone marrow plus G CSF mobilized peripheral blood stem cells without ex vivo T cell depletion Methods In this study, 58 patients, including 33 with high risk or advanced leukemia, were transplanted with cells from an HLA haploidentical family donor with 1-3 mismatched loci After conditioning, patients received G CSF primed bone marrow grafts that had not been depleted ex vivo of T cells, in combination with G CSF mobilized peripheral blood stem cells, as well as GVHD prophylaxis Result All patients achieved sustained, full donor type engraftment The incidence of grade Ⅱ Ⅳ aGVHD was 37 9%, including 3 patients with grade Ⅲ Ⅳ aGVHD The development of aGVHD was not associated with the extent of HLA disparity Chronic GVHD was observed in 30 of 51 evaluable patients (65 4%) Fourteen patients died among whom 7 died of recurrent disease and 7 of transplant related complications Forty four of the 58 patients survived, and 42 remained disease free at the time of a median follow up of 12 months (3 5 to 39 5 months) The 2 year probabilities of disease free survival were 74 8% and 69 3% for standard and high risk patients, respectively Conclusion We developed a new method to use bone marrow from haploidentical family donors without ex vivo T cell depletion, in combination with G PBSCs, as a source of stem cells even in cases of HLA mismatched transplantation
