G-CSF-primed haploidentical marrow transplantation without ex vivo T cell depletion: an excellent alternative for high-risk leukemia.
Based on our encouraging results of G-CSF-primed HLA-matched related marrow transplants for high-risk leukemia, we extended the study from matched related to haploidentical transplants using G-CSF primed marrow and sequential immunosuppressants to prevent both graft-versus-host disease (GVHD) and host-versus-graft rejection (HVGR). Fifteen high-risk leukemia patients, who needed urgent transplantation but lacked an HLA-matched donor, underwent G-CSF-primed haploidentical marrow transplantation without ex vivo T cell depletion. Donors were given G-CSF (Lenograstim) at 3-4 microg/kg/day for 7 days prior to marrow harvest. GVHD and HVGR prophylaxis were combined in the sequential usage of cyclosporin A, methotrexate, anti-thymocyte globulin and mycophenolate mofetil. All patients established sustained trilineage engraftment at a median of 19 days and 21 days for neutrophil and platelets respectively. G-CSF priming significantly increased CD34(+) and CFU-GM cells, reduced total lymphocytes and reversed the CD4(+)/CD8(+) ratio in the donor marrow. The incidence of grade II-IV acute GVHD was 33.3%. Nine patients survived more than a year with a Karnofsky performance status of 100%. Estimated overall disease-free survival at 2 years was 60 +/- 7%. In conclusion, using G-CSF priming marrow grafts along with sequential immunosuppressants provided an excellent alternative for the treatment of high-risk hematological malignancy in patients who lack matched donors.
Ji
S-Q
SQ
Research Center for Hematology, The General Hospital of Air Force, PLA, Beijing, PR China.
Chen
H-R
HR
Wang
H-X
HX
Yan
H-M
HM
Zhu
L
L
Liu
J
J
Xue
M
M
Xun
C-Q
CQ
D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001853:Bone Marrow / Q000187:drug effects*; D019070:Cell Lineage; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D006680:HLA Antigens / Q000235:genetics; D006239:Haplotypes / Q000235:genetics; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000078224:Lenograstim; D007938:Leukemia / Q000453:epidemiology / Q000628:therapy*; D015993:Life Tables; D008212:Lymphocyte Depletion; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D011994:Recombinant Proteins / Q000494:pharmacology*; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013601:T-Lymphocytes; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000078224:Lenograstim; D016572:Cyclosporine; D009173:Mycophenolic Acid; D008727:Methotrexate