Transfusion of peripheral blood stem cells from donor homozygous for a shared HLA-haplotype: avoiding fatal transfusion-associated graft-versus-host disease while preserving anti-leukemic effect.
BACKGROUND
Fatal transfusion-associated graft-versus-host disease was observed in immunocompetent patients transfused with blood from donors homozygous for a shared haplotype with the recipient (the P-F1 barrier). We tested whether it was possible to carry out successful transplantation in a patient with relapsed acute myeloid leukemia, using peripheral blood stem cells from his HLA-homozygous brother (HLA A2, B46, DRB1 901) who shared a haplotype with the patient (HLA A2, B46,75, DRB1 901,12).


METHODS
A CD34 positively selected cell fraction (5.46x 10(6) CD34 cells/kg) was infused first, followed by subsequent infusion of graded doses of donor T cells (total 7.25x10(7) T cells/kg). Nonmyeloablative chemotherapy with idarubicin and cytarabine was given during the transplantation to reduce the leukemic burden and facilitate engraftment. Polymerase chain reaction with the VNTR primers, D1S80, was used to detect engraftment.


RESULTS
Complete remission (>300days) and successful donor engraftment (90%) were achieved.


CONCLUSIONS
Peripheral blood stem cells transplantation from a donor with a homozygous shared haplotype is possible with a minimal preparative regimen.
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital.
R
R
Wong
F Y
FY
Lau
C H
CH
Chui
K S
KS
Tsang
K W
KW
Chik
C K
CK
Li
G
G
Cheng
D000208:Acute Disease; D000328:Adult; D001803:Blood Transfusion; D003561:Cytarabine / Q000627:therapeutic use; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000235:genetics*; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation; D006720:Homozygote; D006801:Humans; D015255:Idarubicin / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000517:prevention & control; D008297:Male
D006680:HLA Antigens; D003561:Cytarabine; D015255:Idarubicin