title: Allogeneic stem cell transplantation for refractory adult T-cell leukemia using a non-T-cell-depleted HLA-incompatible family donor graft, with reference to the grown-up child donor to parent recipient setting: report of a pilot study.
abstract: To increase the availability of alternative stem-cell donors for patients with adult T-cell leukemia (ATL), we examined the feasibility of HLA-incompatible family transplantation, especially from a grown-up child (donor) to a parent (recipient). Since January 2004, seven patients with advanced-phase ATL (three males and four females, median age 59 years), for whom a timely HLA-compatible donor was unavailable, were enrolled. All patients received allografts from their HLA-incompatible sons with reduced-intensity conditioning stem cell transplantation (RIST). Combined graft-versus-host disease (GVHD) prophylaxis involved cyclosporine A or tacrolimus, mycophenolate mofetil or corticosteroid, and short-term methotrexate. All patients achieved prompt engraftment, and there was no 100-day relapse-related mortality. Only one patient had grade-IV acute-GVHD, but this was resolved. The median follow-up period was 251 days (range 112-1,018 days), and the estimated 1-year overall and 1-year progression-free survival rates were 57.1 and 28.6%, respectively. Four patients died, with causes of death being relapse (n = 2), transplantation-associated microangiopathy (n = 1), and septicemia (n = 1). Three are currently alive: two are in complete remission and one has stable disease. Despite a high rate of relapse, RIST using an allograft from an HLA-incompatible grown-up child donor may be feasible for patients with advanced-phase ATL, and may prolong survival.
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. yunarief@m.ehime-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Atsuo
authors.initials: A
authors.lastname: Ozaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshimitsu
authors.forename: Heiichiro
authors.initials: H
authors.lastname: Hamada
authors.forename: Izumi
authors.initials: I
authors.lastname: Masamoto
authors.forename: Kakushi
authors.initials: K
authors.lastname: Matsushita
authors.forename: Masaki
authors.initials: M
authors.lastname: Yasukawa
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
mesh_terms: D033001:Directed Tissue Donation; D005260:Female; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D015458:Leukemia, T-Cell / Q000628:therapy*; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous