title: Successful treatment of refractory T-cell acute lymphoblastic leukemia by unmanipulated stem cell transplantation from an HLA 3-loci mismatched (haploidentical) sibling.
abstract: We describe a patient with refractory T-cell acute lymphoblastic leukemia who successfully underwent unmanipulated stem cell transplantation from an HLA 3-loci mismatched (haploidentical) sibling. In order to avoid severe graft-versus-host disease (GVHD), we used intensified GVHD prophylaxis consisting of tacrolimus, a short course of methotrexate, methylprednisolone, and mycophenolate mofetil. Hematopoietic reconstitution was rapid, with neutrophil count >5 x 10(8)/l on day +16, and platelet count >2 x 10(10)/l on day +25. There was no evidence of clinical acute GVHD. Bacterial, fungal, and viral infections were well controlled with antibiotics. The patient is still in complete remission past day +400. We suggest that unmanipulated HLA-mismatched transplantation with intensified GVHD prophylaxis is an alternative option for patients who do not have an HLA-identical donor.
authors.affiliation: Department of Molecular Medicine, Osaka University Graduate School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ikegame
authors.forename: Y
authors.initials: Y
authors.lastname: Tanji
authors.forename: N
authors.initials: N
authors.lastname: Kitai
authors.forename: H
authors.initials: H
authors.lastname: Tamaki
authors.forename: M
authors.initials: M
authors.lastname: Kawakami
authors.forename: T
authors.initials: T
authors.lastname: Fujioka
authors.forename: Y
authors.initials: Y
authors.lastname: Oka
authors.forename: E
authors.initials: E
authors.lastname: Maruya
authors.forename: H
authors.initials: H
authors.lastname: Saji
authors.forename: H
authors.initials: H
authors.lastname: Sugiyama
authors.forename: H
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D006086:Graft vs Host Disease / Q000517:prevention & control; D006238:Haploidy; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015458:Leukemia, T-Cell / Q000628:therapy*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D035781:Siblings; D014019:Tissue Donors
chemical_list: D007166:Immunosuppressive Agents