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Ding L, Han DM, Yan HM, Zhou JX, Zheng XL, Zhu L, Xue M, Liu J, Mao N, Guo ZK, Ning HM, Wang HX, Zhu H. Infusion of haploidentical HSCs combined with allogenic MSCs for the treatment of ALL patients. Bone Marrow Transplant 2022; 57:1086-1094. [PMID: 35468947 DOI: 10.1038/s41409-022-01688-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Abstract
Although haploidentical stem cell transplantation (haplo-HSCT) offers almost all acute lymphoblastic leukaemia (ALL) patients an opportunity for immediate transplantation, it exhibits a higher incidence of graft failure and graft versus host disease (GVHD). Mesenchymal stem cells (MSCs) are characterised by their haematopoiesis-promoting and immunomodulatory capacity. Thus, we designed a combination of haplo-HSCT and MSCs for ALL patients. ALL patients (n = 110) were given haploidentical HSCs combined with allogenic MSCs, and ALL patients without MSC infusion (n = 56) were included as controls. The 100-day cumulative incidences of grade ≥2 acute GVHD (aGVHD) and grade ≥3 aGVHD were 40.00% and 9.09% compared to 42.32% (P = 0.79) and 22.79% (P = 0.03) in patients without MSC infusion, respectively. The 3-year cumulative incidences of chronic GVHD (cGVHD) and extensive cGVHD were 22.27% and 10.27% compared to 32.14% (P = 0.19) and 22.21% (P = 0.04) in patients without MSC infusion, respectively. No significant differences in the 3-year relapse incidence, nonrelapse mortality, leukaemia-free survival or overall survival in groups with and without MSC cotransplantation were observed. Multivariate analysis showed that MSC infusion contributed to a lower risk of developing extensive cGVHD. Our data suggested that haplo-HSCT combined with MSCs may provide an effective and safe treatment for ALL patients.
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Affiliation(s)
- Li Ding
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China. .,Department of Experimental Hematology& Biochemistry, Beijing Institute of Radiation Medicine, Road Taiping 27, Beijing, 100850, P.R. China.
| | - Dong-Mei Han
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China
| | - Hong-Min Yan
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China
| | - Jie-Xin Zhou
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China
| | - Xiao-Li Zheng
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China
| | - Ling Zhu
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China
| | - Mei Xue
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China
| | - Jing Liu
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China
| | - Ning Mao
- Beijing Institute of Basic Medical Sciences, Road Taiping 27, Beijing, 100850, P.R. China
| | - Zi-Kuan Guo
- Department of Experimental Hematology& Biochemistry, Beijing Institute of Radiation Medicine, Road Taiping 27, Beijing, 100850, P.R. China.,Beijing Institute of Basic Medical Sciences, Road Taiping 27, Beijing, 100850, P.R. China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, 100850, People's Republic of China
| | - Hong-Mei Ning
- Beijing Institute of Basic Medical Sciences, Road Taiping 27, Beijing, 100850, P.R. China.,The Fifth Medical Center of Chinese PLA General Hospital, East Street 8, Beijing, 100071, People's Republic of China
| | - Heng-Xiang Wang
- Air Force Medical Center, PLA, Road Fucheng 30, Beijing, 100142, P.R. China.
| | - Heng Zhu
- Department of Experimental Hematology& Biochemistry, Beijing Institute of Radiation Medicine, Road Taiping 27, Beijing, 100850, P.R. China. .,Beijing Institute of Basic Medical Sciences, Road Taiping 27, Beijing, 100850, P.R. China. .,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, 100850, People's Republic of China. .,Graduate School of Anhui Medical University, Road Meishan 81, Hefei, 230032, Anhui, P.R. China.
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Ding L, Han DM, Zheng XL, Yan HM, Xue M, Liu J, Zhu L, Guo ZK, Mao N, Ning HM, Wang HX, Heng Zhu. Infusion of haploidentical hematopoietic stem cells combined with mesenchymal stem cells for treatment of severe aplastic anemia in adult patients yields curative effects. Cytotherapy 2021; 24:205-212. [PMID: 34799271 DOI: 10.1016/j.jcyt.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/11/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AIMS Despite the great advances in immunosuppressive therapy for severe aplastic anemia (SAA), most patients are not completely cured. Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has been recommended as an alternative treatment in adult SAA patients. However, haplo-HSCT presents a higher incidence of graft failure and graft-versus-host disease (GVHD). The authors designed a combination of haplo-HSCT and umbilical cord-derived mesenchymal stem cells (UC-MSCs) for treatment of SAA in adult patients and evaluated its effects. METHODS Adult patients (≥18 years) with SAA (N = 25) were given HLA-haploidentical hematopoietic stem cells (HSCs) combined with UC-MSCs after a conditioning regimen consisting of busulfan, cyclophosphamide, fludarabine and anti-thymocyte globulin and intensive GVHD prophylaxis, including cyclosporine, basiliximab, mycophenolate mofetil and short-term methotrexate. Additionally, the effects of the protocol in adult SSA patients were compared with those observed in juvenile SAA patients (N = 75). RESULTS All patients achieved myeloid engraftment after haplo-HSCT at a median of 16.12 days (range, 11-26). The median time of platelet engraftment was 28.30 days (range, 13-143). The cumulative incidence of grade II acute GVHD (aGVHD) at day +100 was 32.00 ± 0.91%. No one had grade III-IV aGVHD at day +100. The cumulative incidence of total chronic GVHD was 28.00 ± 0.85%. The overall survival was 71.78 ± 9.05% at a median follow-up of 42.08 months (range, 2.67-104). Promisingly, the protocol yielded a similar curative effect in both young and adult SAA patients. CONCLUSIONS The authors' data suggest that co-transplantation of HLA-haploidentical HSCs and UC-MSCs may provide an effective and safe treatment for adult SAA.
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Affiliation(s)
- Li Ding
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China; Department of Experimental Hematology and Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China.
| | - Dong-Mei Han
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Xiao-Li Zheng
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Hong-Min Yan
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Mei Xue
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Jing Liu
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Ling Zhu
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Zi-Kuan Guo
- Department of Experimental Hematology and Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Ning Mao
- Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Hong-Mei Ning
- Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China; The Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Heng-Xiang Wang
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Heng Zhu
- Department of Experimental Hematology and Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China; Graduate School of Anhui Medical University, Hefei, People's Republic of China
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Ding L, Han DM, Zheng XL, Yan HM, Xue M, Liu J, Zhu L, Li S, Mao N, Guo ZK, Ning HM, Wang HX, Zhu H. A study of human leukocyte antigen-haploidentical hematopoietic stem cells transplantation combined with allogenic mesenchymal stem cell infusion for treatment of severe aplastic anemia in pediatric and adolescent patients. Stem Cells Transl Med 2020; 10:291-302. [PMID: 32978903 PMCID: PMC7848315 DOI: 10.1002/sctm.20-0345] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 01/03/2023] Open
Abstract
The clinical applications of human leukocyte antigen (HLA) haploidentical hematopoietic stem cells transplantation (haplo‐HSCT) have offered most of the young severe aplastic anemia (SAA) patients an opportunity to accept curative therapy at the early stage of bone marrow lesions. However, the outcome of juvenile SAA patients received haplo‐HSCT remain to be improved due to high incidence of graft failure and graft vs host disease (GVHD). Mesenchymal stem cells (MSCs) have been characterized by their hematopoiesis‐supporting and immunomodulatory properties. In the current study, we designed a combination of haplo‐HSCT with allogenic MSC for treatment of SAA in pediatric and adolescent patients and evaluated its effects. Juvenile patients (<18 years) with SAA (n = 103) were given HLA‐haploidentical HSC combined with allogenic MSC after a conditioning regimen consisting of busulfan, cyclophosphamide, fludarabine, and antithymocyte globulin and an intensive GVHD prophylaxis, including cyclosporine, short‐term methotrexate, mycophenolate mofetil, and basiliximab. Neutrophil engraftment was achieved in 102 of 103 patients in a median time of 14.3 days (range 9‐25 days). The median time of platelet engraftment was 25.42 days (range 8‐93 days). The cumulative incidence of II‐IV acute GVHD at day +100 was 26.32% ± 0.19% and III‐IV acute GVHD was 6.79% ± 0.06% at day +100, respectively. The cumulative incidence of chronic GVHD was 25.56% ± 0.26%. The overall survival was 87.15% ± 3.3% at a median follow‐up of 40 (1.3‐98) months. Our data suggest that cotransplantation of HLA‐haploidentical HSC and allogenic mesenchymal stem cell may provide an effective and safe treatment for children and adolescents with SAA who lack matched donors.
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Affiliation(s)
- Li Ding
- Air Force Medical Center, PLA, Beijing, People's Republic of China.,Department of Experimental Hematology & Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China
| | - Dong-Mei Han
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Xiao-Li Zheng
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Hong-Min Yan
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Mei Xue
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Jing Liu
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Ling Zhu
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Sheng Li
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Ning Mao
- Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Zi-Kuan Guo
- Department of Experimental Hematology & Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China.,Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Hong-Mei Ning
- Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China.,The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Heng-Xiang Wang
- Air Force Medical Center, PLA, Beijing, People's Republic of China
| | - Heng Zhu
- Department of Experimental Hematology & Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China.,Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China.,Graduate School of Anhui Medical University, Hefei, Anhui, People's Republic of China
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[Outcome of haploidentical hematopoietic stem cell transplantation for non-Hodgkin lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:656-60. [PMID: 27587245 PMCID: PMC7348539 DOI: 10.3760/cma.j.issn.0253-2727.2016.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
目的 探讨单倍型造血干细胞移植(Haplo-HSCT)治疗复发难治侵袭性非霍奇金淋巴瘤(NHL)患者的疗效和安全性。 方法 回顾性分析2004年1月至2015年3月采用亲缘Haplo-HSCT治疗的26例复发难治侵袭性NHL患者临床资料。 结果 26例患者中弥漫大B细胞淋巴瘤(DLBCL)4例,滤泡性淋巴瘤1例,B淋巴母细胞淋巴瘤/白血病5例,T淋巴母细胞淋巴瘤/白血病9例,间变性大细胞淋巴瘤(ALK阴性)1例,外周T细胞淋巴瘤(非特指型)5例,NK/T细胞淋巴瘤1例。Ann Arbor分期:Ⅲ期6例,Ⅳ期20例。26例患者移植前状态:第1次完全缓解(CR1) 7例,第2次完全缓解(CR2)4例,部分缓解(PR)7例,疾病稳定(SD)1例,疾病进展(PD)7例。其中复发难治性病例19例。移植后26例患者均获粒系造血重建,粒细胞中位植入时间为12(11~17) d。25例患者获巨核系造血重建,血小板中位植入时间为14(11~31) d。所有患者在+30 d经植入鉴定证实为完全供者嵌合体。中位随访时间14(4~136)个月,26例患者中20例(76.92%)存活,15例(57.69%)无病存活,7例(26.92%)复发(其中2例死亡,5例存活)。预处理相关不良反应经对症处理后症状均消失。Haplo-HSCT后2年累积复发率为42.20%;2年总生存(OS)率为71.60%;2年无病生存(DFS)率为48.90%。移植前CR患者移植后2年OS与DFS率均明显高于移植前未达CR的患者(OS:100.0%对52.4%,P=0.023;DFS:88.9%对27.0%,P=0.013)。 结论 对于不适合行自体造血干细胞移植且无完全相合供者的复发难治侵袭性NHL患者,尝试进行Haplo-HSCT有效、安全。
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Zhu L, Wang Z, Zheng X, Ding L, Han D, Yan H, Guo Z, Wang H. Haploidentical hematopoietic stem cell transplant with umbilical cord-derived multipotent mesenchymal cell infusion for the treatment of high-risk acute leukemia in children. Leuk Lymphoma 2014; 56:1346-52. [DOI: 10.3109/10428194.2014.939970] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hematopoietic stem cell transplantation with umbilical cord multipotent stromal cell infusion for the treatment of aplastic anemia—a single-center experience. Cytotherapy 2013; 15:1118-25. [DOI: 10.1016/j.jcyt.2013.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW In the last few years, mobilized peripheral blood has overcome bone marrow as a graft source, but, despite the evidence of a more rapid engraftment, the incidence of chronic graft-versus-host disease is significantly higher with, consequently, more transplant-related mortality on the long follow-up. Overall, the posttransplant outcome of mobilized peripheral blood recipients is similar to that of patients who are bone marrow grafted. More recently, the use of bone marrow after granulocyte colony-stimulating factor (G-CSF) donor priming has been introduced in the transplant practice. Herein, we review biological acquisitions and clinical results on the use of G-CSF-primed bone marrow as a source of hematopoietic stem cells (HSC) for allogeneic stem cell transplantation. RECENT FINDINGS G-CSF the increases the HSC compartment and exerts an intense immunoregulatory effect on marrow T-cells resulting in the shift from Th1 to Th2 phenotype with higher production of anti-inflammatory cytokines. The potential advantages of these biological effects have been translated in the clinical practice by using G-CSF primed unmanipulated bone marrow in the setting of transplant from human leukocyte antigen (HLA)-haploidentical donor with highly encouraging results. SUMMARY For patients lacking an HLA-identical sibling, the transplant of G-CSF primed unmanipulated bone marrow from a haploidentical donor combined with an intense in-vivo immunosuppression is a valid alternative achieving results that are well comparable with those reported for umbilical cord blood, HLA-matched unrelated peripheral blood/bone marrow or T-cell-depleted haploidentical transplant.
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Crocchiolo R, Castagna L, Fürst S, El-Cheikh J, Faucher C, Oudin C, Granata A, Bouabdallah R, Coso D, Chabannon C, Balzarotti M, Santoro A, Blaise D. Tandem autologous-allo-SCT is feasible in patients with high-risk relapsed non-Hodgkin's lymphoma. Bone Marrow Transplant 2012; 48:249-52. [PMID: 22732704 DOI: 10.1038/bmt.2012.116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allo-SCT is used to exploit GVL effect in high-risk relapsed non-Hodgkin's lymphoma (NHL). Here, we retrospectively analyzed 34 high-risk NHL patients who underwent auto-SCT followed closely by reduced-intensity allo-SCT ('tandem auto-allo') from January 2002 to November 2010. The search for an allogeneic donor was started at the beginning of salvage regimen. Median patients' age was 47 (27-68) years; histotypes were: diffuse large B-cell n=5, follicular n=14, transformed follicular n=4, mantle-cell n=5, plasmocytoid lymphoma n=1, anaplastic large T-cell n=2, peripheral T-cell n=3. Donors were HLA-identical siblings (n=29) or 10/10-matched unrelated individuals (n=5). Median interval between auto-SCT and allo-SCT was 77 days (36-197). At a median follow-up of 46 (8-108) months since allo-SCT, 5-year OS is 77% (61-93) and PFS is 68% (51-85). Disease relapse or progression occurred in six patients, 100-day TRM was 0%, 2-year TRM incidence was 6%. In conclusion, tandem transplantation is feasible in high-risk NHL patients having a HLA-identical donor. This approach could represent a suitable therapeutic option for those patients with high-risk NHL potentially benefitting from further therapy after auto-SCT. Donor searches should be started promptly whenever such an approach is chosen.
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Affiliation(s)
- R Crocchiolo
- Département d'Hématologie, Programme de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France.
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Luo XH, Huang XJ, Li D, Liu KY, Xu LP, Liu DH. Immune reconstitution to cytomegalovirus following partially matched-related donor transplantation: impact ofin vivoT-cell depletion and granulocyte colony-stimulating factor-primed peripheral blood/bone marrow mixed grafts. Transpl Infect Dis 2012; 15:22-33. [PMID: 22372613 DOI: 10.1111/j.1399-3062.2012.00722.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/15/2011] [Accepted: 11/25/2011] [Indexed: 01/24/2023]
Affiliation(s)
- X.-H. Luo
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - X.-J. Huang
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - D. Li
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - K.-Y. Liu
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - L.-P. Xu
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - D.-H. Liu
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
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The role of transplantation in diffuse large B-cell lymphoma: the impact of rituximab plus chemotherapy in first-line and relapsed settings. Curr Hematol Malig Rep 2011; 6:47-57. [PMID: 21190142 DOI: 10.1007/s11899-010-0075-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rituximab has improved the prognosis of patients with diffuse large B-cell lymphoma, but a high proportion of patients with advanced disease will relapse or will fail to achieve a remission with front-line treatment. Salvage chemotherapy, followed by high-dose chemotherapy or radiation therapy and autologous stem cell transplantation, remains the best treatment option for such patients, especially those who retain chemosensitivity. Allogeneic transplantation is under investigation in this setting, often as a treatment for relapse after autologous transplantation. Treatment-related mortality due to graft-versus-host disease, preparative regimen toxicity, and poor immune recovery often limits its benefits. This article reviews the role of hematopoietic stem cell transplantation in the treatment of diffuse large B-cell lymphoma, the incorporation of rituximab, and avenues of clinical investigation in this rapidly evolving field.
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Hu YX, Cui Q, Liang B, Huang H. Relapsing Hematologic Malignancies after Haploidentical Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2011; 17:1099-111. [DOI: 10.1016/j.bbmt.2011.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/11/2011] [Indexed: 11/16/2022]
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Chang YJ, Huang XJ. Use of G-CSF-stimulated marrow in allogeneic hematopoietic stem cell transplantation settings: a comprehensive review. Clin Transplant 2011; 25:13-23. [DOI: 10.1111/j.1399-0012.2010.01298.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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