Haploidentical allogeneic bone marrow stem cell transplantation combined with peripheral blood stem cells for therapy of leukemia / 中国实验血液学杂志

ABSTRACT

The purpose of this study was to investigate the feasibility and clinical outcome of granulocyte colony stimulating factor (G-CSF)-mobilized haploidentical bone marrow transplantation combined with peripheral blood stem cells (hiBM+PBSCT) for therapy of leukemia. 125 leukemia patients underwent G-CSF primed haploidentical stem cell transplantation without ex-vivo T cell depletion. All haploidentical donors were injected with G-CSF at dose of 5 microg/(kg.d) for 7 days. The patients were divided into groups A and B. 29 patients in group A underwent hiBM+PBSCT at 7th and 8th days of mobilization in donors with G-CSF respectively; 96 patients in group B underwent hiBMT. All patients received the same GVHD prophylaxis regimen, the clinical outcomes were investigated. The results showed that all patients except one CML-myelofibrosis patient achieved trilineage engraftment. Engraftment median times were 15 and 19 days for neutrophil and platelet in group A respectively, while engraftment median times were 18 and 23 days for neutrophil and platelet in group B respectively. The incidences of grade II-IV aGVHD were 31.03% in group A and 12.5% in group B respectively (p<0.05). The incidences of grade III-IV aGVHD was 13.79% and 10.41% in group A and group B (p>0.05). The aGVHD-related death incidence was 3.45% and 5.21% in group A and group B (p>0.05). The incidence of grade II-IV cGVHD was 48.2% and 35.4% in group A and group B respectively (p>0.05). The incidence of extensive cGVHD was 23.3% and 15.6% in group A and group B respectively (p>0.05). The disease relapse rate was 6.8% (2/29) and 18.75% (18/96) in group A and group B respectively (p<0.05). It is concluded that the G-CSF-mobilized allogeneic haploidentical BM plus peripheral blood HSCT without T cell depletion provides a rapid and sustained engraftment without increase of severe GVHD, furthermore, the relapse rate of disease is reduced remarkably, thus this method can be used in clinic.