HLA-haploidentical nonmyeloablative stem cell transplantation: induction to tolerance without passing through mixed chimaerism.
There are few reports of unmanipulated HLA-haploidentical nonmyeloablative stem cell transplantation (NST) using only pharmacological acute graft-vs.-host disease (GVHD) prophylaxis. We present here a successful case of unmanipulated HLA-haploidentical NST for mediastinal large B cell lymphoma that was resistant to autologous peripheral blood stem cell transplantation (PBSCT). The conditioning regimen consisted of fludarabine, busulfan and rabbit anti-T-lymphocyte globulin (ATG) in addition to rituximab. GVHD prophylaxis was performed using tacrolimus and methylprednisolone 1 mg/kg. The patient had rapid engraftment, with 100% donor chimaerism in the lineages of both T cells and granulocytes on day +12, but developed no GVHD clinically. The patient is still in complete remission past day +1020, with no sign of chronic GVHD without receiving immunosuppressive agents. HLA-haploidentical NST may be performed without utilizing mixed chimaerism.
Ikegame
K
K
Department of Molecular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Kawakami
M
M
Yamagami
T
T
Maeda
H
H
Onishi
K
K
Taniguchi
Y
Y
Fujioka
T
T
Masuda
T
T
Kawase
I
I
Ogawa
H
H
D000328:Adult; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016393:Lymphoma, B-Cell / Q000628:therapy; D008479:Mediastinal Neoplasms / Q000628:therapy; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods