In this study we investigated the feasibility and clinical value of non T-cell depleted bone marrow transplantation (BMT) from HLA haploidentical related donor in patients with high risk hematological malignancies. Between August 2005 and May 2010, 71 patients were transplanted for AML (n=42), ALL (n=13), CML (n=5), Hodgkin lymphoma (n=5), plasmacell leukemia (n=3), myelofibrosis (n=2) and myelodisplastic syn- drome (n=1). Their median age was 35 years (5-71). Thirty nine patients were in early stage (CR 1, n=27; CR2, n=12) and 32 in advanced stage (CR3, n=7; active disease, n=25). All donors were HLA identical at 1 haplotype and mismatched for 2 (n=24) or 3 (n=47) loci on the unshared haplotype. Ten patients received a reduced intensity conditioning (RIC) consisting of Fludarabine (Flu) alone (n=1), Flu + Thiotepa (Thio) + Melpha- lan (n=2) or Thio + i.v. Busulfan (Bu) + Flu (TBF-RIC, n=7), and 61 patients received a myeloablative conditioning (MAC) consisting of Aracytin + Cyclophosphamide combined with TBI (n=7) or Treosulphan (n=11) or oral Bu (n=11), whereas the last 32 consecutive patients underwent transplant after condition- ing with TBF-MAC. All patients received an identical graft-ver- sus-host disease (GvHD) prophylaxis consisting of Fresenius Antithymocyte Globulin combined with Cyclosporine, Meth- otrexate, Mycophenolate Mofetil and Basiliximab. Marrow cells were harvested from all donors after priming with Filgrastim at 3-4 microg/Kg/d from day -7 to -1 and were infused unmanipu- lated on day 0. The median dose of total nucleated, CD34+ and CD3+ cells infused was 7.8 (1-28) x108/kg, 2.1 (0.8-11) x106/Kg and 28 (10-98) x106/Kg, respectively. One patient had a primary graft failure. Results in terms of cumulative incidence (CI) of PMN engraftment, acute and chronic GvHD, relapse, transplant related mortality (TRM) and Kaplan Meyer overall survival (OS) are given in the Table. The 1 year OS for the 32 patients transplanted with TBF-MAC was 72% in 18 patients transplanted in early stage and 36% in 14 patients transplanted in advanced stage (see Figure). The OS for 10 patients who received a reduced intensity conditioning was 66% at 1 year. These results show that BMT from haploidentical donor using unmanipulated marrow cells and an intensive regimen for GVHD prophylaxis is correlated with high engraftment rate, low incidence of acute and chronic GVHD, reasonable TRM and favourable patient outcome.
Santarone, S., Di Bartolomeo, P., De Angelis, G., Picardi, A., Bavaro, P., Di Bartolomeo, E., et al. (2011). Unmanipulated bone marrow transplantation from haplo-identical related donor for patients with high-risk haematological malignancies. BONE MARROW TRANSPLANTATION, 46(supp. 1), 349-349.
Unmanipulated bone marrow transplantation from haplo-identical related donor for patients with high-risk haematological malignancies
PICARDI, ALESSANDRA;CUDILLO, LAURA;ARCESE, WILLIAM
2011-01-01
Abstract
In this study we investigated the feasibility and clinical value of non T-cell depleted bone marrow transplantation (BMT) from HLA haploidentical related donor in patients with high risk hematological malignancies. Between August 2005 and May 2010, 71 patients were transplanted for AML (n=42), ALL (n=13), CML (n=5), Hodgkin lymphoma (n=5), plasmacell leukemia (n=3), myelofibrosis (n=2) and myelodisplastic syn- drome (n=1). Their median age was 35 years (5-71). Thirty nine patients were in early stage (CR 1, n=27; CR2, n=12) and 32 in advanced stage (CR3, n=7; active disease, n=25). All donors were HLA identical at 1 haplotype and mismatched for 2 (n=24) or 3 (n=47) loci on the unshared haplotype. Ten patients received a reduced intensity conditioning (RIC) consisting of Fludarabine (Flu) alone (n=1), Flu + Thiotepa (Thio) + Melpha- lan (n=2) or Thio + i.v. Busulfan (Bu) + Flu (TBF-RIC, n=7), and 61 patients received a myeloablative conditioning (MAC) consisting of Aracytin + Cyclophosphamide combined with TBI (n=7) or Treosulphan (n=11) or oral Bu (n=11), whereas the last 32 consecutive patients underwent transplant after condition- ing with TBF-MAC. All patients received an identical graft-ver- sus-host disease (GvHD) prophylaxis consisting of Fresenius Antithymocyte Globulin combined with Cyclosporine, Meth- otrexate, Mycophenolate Mofetil and Basiliximab. Marrow cells were harvested from all donors after priming with Filgrastim at 3-4 microg/Kg/d from day -7 to -1 and were infused unmanipu- lated on day 0. The median dose of total nucleated, CD34+ and CD3+ cells infused was 7.8 (1-28) x108/kg, 2.1 (0.8-11) x106/Kg and 28 (10-98) x106/Kg, respectively. One patient had a primary graft failure. Results in terms of cumulative incidence (CI) of PMN engraftment, acute and chronic GvHD, relapse, transplant related mortality (TRM) and Kaplan Meyer overall survival (OS) are given in the Table. The 1 year OS for the 32 patients transplanted with TBF-MAC was 72% in 18 patients transplanted in early stage and 36% in 14 patients transplanted in advanced stage (see Figure). The OS for 10 patients who received a reduced intensity conditioning was 66% at 1 year. These results show that BMT from haploidentical donor using unmanipulated marrow cells and an intensive regimen for GVHD prophylaxis is correlated with high engraftment rate, low incidence of acute and chronic GVHD, reasonable TRM and favourable patient outcome.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
