title: Spousal hematopoietic stem cell transplantation.
abstract: We report a pilot series of five patients who received stem cell transplantation (SCT) from a spouse for post-transplant relapse or rejection. The inclusion criterion regarding HLA disparities was three or fewer antigen mismatches in the graft-versus-host direction at the HLA-A, B, and DR loci. Four patients received spousal SCT as a third transplant attempt after post-transplant relapse and one as rescue for graft rejection. The reduced intensity conditioning (RIC) regimen consisted of fludarabine, melphalan, and anti-thymocyte globulin (ATG) with 3 Gy of total body irradiation (TBI) for relapse cases and ATG plus 4 Gy of TBI for the rejection case. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus, methylprednisolone, and mycophenolate mofetil. Peripheral blood stem cells were transplanted. Granulocyte engraftment was achieved in all cases between days 9 and 11 (median, 10) with complete spousal chimerism. In three of the five patients, no acute GVHD was observed, while one case developed grade III GVHD and one case grade IV. All four patients evaluable for the anti-leukemic effect achieved complete remission; however, all relapsed between 106 and 334 day post-transplant, and died between days 152 and 548. We suggest that spousal SCT can be performed as a repetitive SCT using a RIC regimen with low-dose ATG and steroid-containing GVHD prophylaxis.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. kame@hyo-med.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ikegame
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Kaida
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.|Department of Transfusion Medicine and Cell Therapy, Hyogo Medical College, Nishinomiya, Hyogo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yoshihara
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.|Department of Transfusion Medicine and Cell Therapy, Hyogo Medical College, Nishinomiya, Hyogo, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Yoshihara
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ishii
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Okada
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Tamaki
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Soma
authors.affiliation: HLA Foundation Laboratory, Kyoto, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kusunoki
authors.affiliation: HLA Foundation Laboratory, Kyoto, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kojima
authors.affiliation: HLA Foundation Laboratory, Kyoto, Japan.
authors.forename: Hiroh
authors.initials: H
authors.lastname: Saji
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D064591:Allografts; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006680:HLA Antigens; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006648:Histocompatibility; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012008:Recurrence; D018454:Spouses; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan
keywords: Graft-versus-host disease; Post-transplant relapse; Reduced intensity conditioning; Spousal transplantation