Megadose CD34+ hemopoietic stem cell transplantation for patients with high risk acute myeloid leukemia who have no HLA matched donor: A pilot study of a full haplotype mismatch transplantation / 대한내과학회지

ABSTRACT

BACKGROUND: Haploidentical transplantation has become a considerable clinical choice for acute myeloid leukemia (AML) patients lacking a HLA matched donor. We tried to reveal the possible role of a full haplotype mismatch transplantation. METHODS: Four patients received stem cell transplantation from their full haplotype mismatched family donors. Conditioning regimen included total-body irradiation, intravenous busulfan, antithymocyte globulin, and fludarabine. Megadose transplants of CD34+ stem cells were in the range of 10.9 x 106/kg and 20.6 x 106/kg. Neither GvHD prophylaxis nor post-transplant G-CSF were given. We monitored patients' bone marrow cellularity and chimerism in the peripheral blood using real time PCR. RESULTS: All patients showed stable engraftment. The most frequent side effect was severe mucositis, but all patients recovered successfully without early death. Nobody showed acute GvHD. Two refractory patients were relapsed early after transplantation. Other 2 patients have been in good clinical condition with follow-up duration of 1~4 months. CONCLSUION We could overcome the main limitations-a GvHD and a graft failure- of a full haplotype mismatch transplantation with a newly developed conditioning regimen that might be used firstly according to review of literature. Although our study sample numbers and duration of follow-up are not enough yet, at least in patients who were in complete remission and categorized as high-risk AML, we suggest that this treatment modality should be considered actively.