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Allogeneic hematopoietic stem cell transplantation from a 2-HLA-haplotype-mismatched family donor for posttransplant relapse: a prospective phase I/II study. Bone Marrow Transplant 2020; 56:70-83. [PMID: 32564055 DOI: 10.1038/s41409-020-0980-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/20/2020] [Accepted: 06/12/2020] [Indexed: 11/08/2022]
Abstract
HLA haploidentical hematopoietic stem cell transplantation (HSCT), i.e., HSCT from a 1-HLA-haplotype-mismatched family donor, has been successfully performed even as a second transplantation for posttransplant relapse. Is the haploidentical the limit of HLA mismatches in HSCT? In order to explore the possibility of HLA-mismatched HSCT from family donors beyond haploidentical relatives, we conducted a prospective phase I/II study of 2-HLA-haplotype-mismatched HSCT (2-haplo-mismatch HSCT). We enrolled 30 patients with posttransplant relapse (acute myeloid leukemia: 18, acute lymphoblastic leukemia: 11, non-Hodgkin lymphoma: 1). 2-haplo-mismatch HSCT was performed as the second to sixth transplantations. The donors were siblings (n = 12), cousins (n = 16), and second cousins (n = 2). The conditioning regimen consisted of fludarabine, cytarabine, melphalan, low-dose anti-thymocyte globulin, and 3 Gy of total body irradiation. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus, methylprednisolone, and mycophenolate mofetil. All patients achieved neutrophil engraftment, except for a case of early death. The cumulative incidences of grades II-IV and III-IV acute GVHD were 36.7% and 16.7%, respectively. The overall survival at 1 year, relapse, and non-relapse mortality rates was 30.1%, 38.9%, and 44.3%, respectively. Considering the poor prognosis of posttransplant relapse, 2-haplo-mismatch HSCT can be an alternative option in a second or third transplantation.
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Ikegame K, Kaida K, Yoshihara S, Yoshihara K, Ishii S, Inoue T, Okada M, Tamaki H, Soma T, Kusunoki Y, Kojima H, Saji H, Ogawa H. Spousal hematopoietic stem cell transplantation. Int J Hematol 2016; 105:646-657. [PMID: 28013483 DOI: 10.1007/s12185-016-2168-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 01/21/2023]
Abstract
We report a pilot series of five patients who received stem cell transplantation (SCT) from a spouse for post-transplant relapse or rejection. The inclusion criterion regarding HLA disparities was three or fewer antigen mismatches in the graft-versus-host direction at the HLA-A, B, and DR loci. Four patients received spousal SCT as a third transplant attempt after post-transplant relapse and one as rescue for graft rejection. The reduced intensity conditioning (RIC) regimen consisted of fludarabine, melphalan, and anti-thymocyte globulin (ATG) with 3 Gy of total body irradiation (TBI) for relapse cases and ATG plus 4 Gy of TBI for the rejection case. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus, methylprednisolone, and mycophenolate mofetil. Peripheral blood stem cells were transplanted. Granulocyte engraftment was achieved in all cases between days 9 and 11 (median, 10) with complete spousal chimerism. In three of the five patients, no acute GVHD was observed, while one case developed grade III GVHD and one case grade IV. All four patients evaluable for the anti-leukemic effect achieved complete remission; however, all relapsed between 106 and 334 day post-transplant, and died between days 152 and 548. We suggest that spousal SCT can be performed as a repetitive SCT using a RIC regimen with low-dose ATG and steroid-containing GVHD prophylaxis.
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Affiliation(s)
- Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Katsuji Kaida
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Satoshi Yoshihara
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.,Department of Transfusion Medicine and Cell Therapy, Hyogo Medical College, Nishinomiya, Hyogo, Japan
| | - Kyoko Yoshihara
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.,Department of Transfusion Medicine and Cell Therapy, Hyogo Medical College, Nishinomiya, Hyogo, Japan
| | - Shinichi Ishii
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takayuki Inoue
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masaya Okada
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroya Tamaki
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshihiro Soma
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | | | | | | | - Hiroyasu Ogawa
- Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Yagyu S, Kuroda H, Fujiki A, Tamura S, Iehara T, Morimoto A, Hosoi H, Sugimoto T, Imashuku S. Successful non-T-cell-depleted HLA-haploidentical 3-loci mismatched bone marrow transplantation. Eur J Haematol 2005; 74:529-32. [PMID: 15876259 DOI: 10.1111/j.1600-0609.2005.00430.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 17-year-old boy with therapy-related acute myelocytic leukemia (FAB classification-M0) successfully received allogeneic non-T-cell depleted (non-TCD) bone marrow transplantation (BMT) from his 3-loci HLA-mismatch mother, although pre-BMT detection of feto-maternal microchimerism was negative. The BMT was performed with reduced intensity conditioning (total body irradiation; 4 Gy, fludarabine; 20 mg/m(2) x 6, and melphalan; 70 mg/m(2) x 2) and short-course methotrexate and tacrolimus for GVHD prophylaxis. Complete donor chimera was obtained on day 19, associated with Grade 3 acute GVHD (skin: Stage 1, liver: Stage 0, gut: Stage 3) that was well controlled with immunosuppressive therapies. At day 200 of transplantation, he was in complete remission with no signs of chronic GVHD. Our case suggests that non-TCD HLA-haploidentical 3-loci mismatched BMT can be safely performed from mother to offspring even when feto-maternal microchimerism is barely detectable with the current detection procedure.
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Affiliation(s)
- Shigeki Yagyu
- Department of Pediatrics, Kyoto City Hospital, Kyoto, Japan.
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Kai T, Kimura H, Shiga Y, Mineishi S, Yoshihara S, Ogawa H, Maruya E, Saji H, Ohto H, Maruyama Y. Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia Rescued with a Second Allogeneic Stem Cell Transplantation from a Haploidentical Mother after Relapse following Cord Blood Transplantation. Int J Hematol 2004; 80:453-7. [PMID: 15646659 DOI: 10.1532/ijh97.04072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 32-year-old female patient who had Philadelphia chromosome-positive acute lymphoblastic leukemia underwent cord blood transplantation while in her second remission. However, she had a hematological and central nervous system relapse 3 months later. After reinduction with imatinib mesylate, unmanipulated peripheral blood stem cell transplantation was performed from the patient's haploidentical mother with a reduced-intensity conditioning regimen. Rabbit antithymocyte globulin, tacrolimus, and methylprednisolone were used for prophylaxis of graft-versus-host disease. Engraftment of neutrophils was observed on day 12, and complete donor chimerism was obtained by day 24. The posttransplantation course was uneventful. Although the patient had a relapse 10 months later, this case demonstrated that transplantation from a haploidentical donor is clearly a feasible alternative for patients who desperately need rescue transplantation.
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MESH Headings
- Adult
- Animals
- Cord Blood Stem Cell Transplantation
- Female
- Haplotypes
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Mothers
- Peripheral Blood Stem Cell Transplantation
- Rabbits
- Radiography
- Remission Induction
- Transplantation Chimera
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- Tatsuyuki Kai
- Hematology, Kita-Fukushima Medical Center, Date, Fukushima, Japan.
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Avivi I, Rowe JM. Acute lymphocytic leukemia: role of hematopoietic stem cell transplantation in current management. Curr Opin Hematol 2003; 10:463-8. [PMID: 14564178 DOI: 10.1097/00062752-200311000-00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It is still unclear what the best postremission therapy is for young adults with acute lymphocytic leukemia (ALL). Encouraging results, supporting the superiority of allogeneic stem cell transplantation in CR1 compared with chemotherapy/ allogeneic stem cell transplantation (ASCT), are coming from the ongoing international prospective MRC UKALL XII /ECOG 2993 study. However, the transplant-related morbidity and mortality remain high. RECENT FINDINGS The detection of persistent minimal residual disease (MRD) after induction and consolidation therapy is being increasingly used to identify high-risk patients for whom allogeneic transplant may offer the only curative option. SUMMARY The ultimate aim is to determine whether the absence of MRD pretransplant can be used as a surrogate for low-risk adult ALL that can be cured without allogeneic transplantation.
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Affiliation(s)
- Irit Avivi
- Department of Hematology and Bone Marrow Transplantation, Ramban Medical Center & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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