HLA-mismatched hematopoietic SCT without in vitro T-cell depletion for myelodysplastic syndrome.
Allogeneic hematopoietic SCT (HSCT) is currently the only curative treatment for myelodysplastic syndrome (MDS). However, many patients cannot find an HLA-matched donor. We have developed a new protocol for HLA-mismatched (including haploidentical) HSCT using G-CSF-primed BM plus G-CSF-mobilized PBSCs without in vitro T-cell depletion. A total of 36 patients diagnosed with high-risk MDS (RAEB (refractory anemia with excess blasts) or RAEBt (RAEB in transformation)) underwent transplantation from HLA-mismatched family donors. All patients achieved sustained myeloid engraftment. The cumulative incidence of grades II-IV acute GVHD (aGVHD) was 60% and that of grades III and IV aGVHD was 15%. The 2-year cumulative incidence of chronic GVHD was 56%. After a median follow-up of 17 months, 4 patients had relapsed and died and 25 patients were still alive. The 2-year probability of leukemia-free survival (LFS) was 65%. Patients transplanted within 7 months of diagnosis had better LFS (89 vs 43% ). Severe aGVHD decreased the LFS significantly by increasing non-relapse mortality (NRM). This study confirms that HLA-mismatched HSCT is a treatment option for MDS. Patients with high-risk MDS benefit from receiving HSCT early in the course of the disease.
Chen
Y
Y
Peking University Institute of Hematology, People's Hospital, Peking University, Beijing, PR China.
Liu
K
K
Xu
L
L
Chen
H
H
Liu
D
D
Zhang
X
X
Shi
H
H
Han
W
W
Wang
Y
Y
Zhao
T
T
Wang
J
J
Wang
J
J
Huang
X
X
D000328:Adult; D016026:Bone Marrow Transplantation; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
D016179:Granulocyte Colony-Stimulating Factor