A novel approach to human leukocyte antigen-mismatched transplantation in patients with malignant hematological disease / 中华医学杂志(英文版)
Chinese Medical Journal
;
(24): 1778-1785, 2004.
Artigo
em Inglês
| WPRIM
| ID: wpr-257360
ABSTRACT
<p><b>BACKGROUND</b>Many patients requiring allogeneic hematopoietic stem cell transplantation (HSCT) do not have an human leukocyte antigen (HLA)-matched donor. Alternative donors, such as HLA mismatched family donors, are associated with higher rates of graft rejection and acute graft versus host disease (aGVHD) if T cells are not first depleted. We developed a new technique for HLA mismatched allogeneic HSCT using G-CSF primed bone marrow plus G-CSF-mobilized peripheral blood stem cells without ex vivo T cell depletion.</p><p><b>METHODS</b>In this study, 58 patients, including 33 with high-risk or advanced leukemia, were transplanted with cells from an HLA-haploidentical family donor with 1 - 3 mismatched loci. After conditioning, patients received G-CSF-primed bone marrow grafts that had not been depleted ex vivo of T cells, in combination with G-CSF-mobilized peripheral blood stem cells, as well as GVHD prophylaxis.</p><p><b>RESULT</b>All patients achieved sustained, full donor-type engraftment. The incidence of grade II-IV aGVHD was 37.9%, including 3 patients with grade III-IV aGVHD. The development of aGVHD was not associated with the extent of HLA disparity. Chronic GVHD was observed in 30 of 51 evaluable patients (65.4%). Fourteen patients died among whom 7 died of recurrent disease and 7 of transplant-related complications. Forty-four of the 58 patients survived, and 42 remained disease free at the time of a median follow-up of 12 months (3.5 to 39.5 months). The 2-year probabilities of disease-free survival were 74.8% and 69.3% for standard- and high-risk patients, respectively.</p><p><b>CONCLUSION</b>We developed a new method to use bone marrow from haploidentical family donors without ex vivo T cell depletion, in combination with G-PBSCs, as a source of stem cells even in cases of HLA mismatched transplantation.</p>
Texto completo:
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Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Farmacologia
/
Recidiva
/
Terapêutica
/
Transplante Homólogo
/
Teste de Histocompatibilidade
/
Mortalidade
/
Fator Estimulador de Colônias de Granulócitos
/
Transplante de Células-Tronco Hematopoéticas
/
Neoplasias Hematológicas
/
Condicionamento Pré-Transplante
Tipo de estudo:
Estudo prognóstico
Limite:
Adolescente
/
Adulto
/
Criança
/
Feminino
/
Humanos
/
Masculino
Idioma:
Inglês
Revista:
Chinese Medical Journal
Ano de publicação:
2004
Tipo de documento:
Artigo
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