HLA 1–3 antigen‐mismatched related peripheral blood stem cells transplantation using low‐dose antithymocyte globulin versus unrelated cord blood transplantation

Abstract Introduction: Numerous factors affect the outcome of Allogeneic Peripheral blood stem cells transplantation (PBSCs). In Egypt, roughly 15 million patients are currently suffering from Hepatitis C (HCV) viremia with 40,000 deaths each year. Aim: To study the impact of HCV viremia on the tempo of engraftment and on incidence of acute and chronic graft versus host disease (GVHD) as well as sinusoidal obstruction syndrome (SOS). Patients and methods: Between March 1997 and June 2014, 332 HCV seropositive patients with various hematological disorders were enrolled; 54 acute lymphoblastic leukemia (ALL), 131 acute myeloid leukemia (AML), 46 severe aplastic anemia (SAA), 29 B thalassemia major (B-TM), 22 chronic myeloid leukemia (CML) and 25 myelodysplastic syndrome (MDS) patients; all received allogeneic peripheral blood stem cells transplantation (PBSCT) at the BMT unit of Nasser Institute hospital for Research and Treatment, Cairo, Egypt . Conditioning regimens using Fludarabine (FLU), Busalphan (BU), cyclophosphamide (CY), antithymocyte globulin (ATG), melphalane (MELPH) and total body irradiation (TBI) differed according to disease entity including (BU/CY, FLU/BU for AML and CML, , BU/CY/ATG for B-TM, TBI/CY for ALL, FLU/CY for SAA and FLU/MELPH). GVHD prophylaxis consisted of methotrexate (MTX) at days 1, 3, 6 & 11 plus Cyclosporin A (CSA) starting from day -1. Mycophenolate mofetil (MMF) was added to cases transplanted using reduced intensity conditioning (RIC). Results: Neutrophil engraftment was reached at a median of 15, 14, 12, 16, 17, and 17 days for ALL, AML, SAA, B-TM, CML and MDS patients, respectively. Platelet engraftment was reached at a median of 11, 12, 13, 15, 22 and 11 days for ALL, AML, SAA, B-TM, CML and MDS patients, respectively. The incidence of SOS was 2.7%, 2.2%, 2.1%, 3.4%, zero%, and zero % in ALL, AML, SAA, B-TM, CML and MDS patients, respectively. Acute GVHD grade 2-4 was reported in 6 ALL, 18 AML, 2 SAA, 3 BTM, 10 CML and 2 MDS patients while chronic GVHD was reported in 7 ALL, 16 AML, 2 SAA, 2 BTM, 3 CML, and 2 MDS patients. Event free survival (EFS) in all disease entities was 44.7% at 3 years & 44.3% at 5 years while overall survival (OS) was 55.9% at 3 years & 54.2 % at 5 years for all patients, respectively. Conclusion: Analysis of 332 HCV positive patients subjected to PBSCT show that HCV does not affect platelet or neutrophil engraftment or the incidence of SOS. HCV viremia does not show a significant impact on the incidence of aGVHD and cGVHD or OS. However, a comparative study with a negative HCV patient's cohort is still ongoing. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

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Peripheral Blood Stem Cells: Transplantation and Beyond

The Oncologist ◽

10.1634/theoncologist.2-1-40 ◽

1997 ◽

Vol 2 (1) ◽

pp. 40-49 ◽

Cited By ~ 9

Author(s):

Albert K.W. Lie ◽

L. Bik To

Keyword(s):

Stem Cells ◽

Peripheral Blood ◽

Peripheral Blood Stem Cells ◽

Blood Stem Cells ◽

Stem Cells Transplantation

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The Disease Status at Transplant Is the Major Factor Association with the Long Term Survival of HLA Haploidentical Peripheral Blood Stem Cells Transplantation.

Blood ◽

10.1182/blood.v104.11.5107.5107 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5107-5107

Author(s):

Binyi Wu ◽

Lanxiao Wu ◽

Kunyuan Guo ◽

Chaoyang Song ◽

Dingan Yan ◽

...

Keyword(s):

Stem Cells ◽

Graft Versus Host Disease ◽

Peripheral Blood ◽

Peripheral Blood Stem Cells ◽

Term Survival ◽

Long Term Survival ◽

Graft Versus Host ◽

Blood Stem Cells ◽

Stem Cells Transplantation

Abstract Objective: To evaluate the factors effecting the long term survival of refractory leukemia patients who received the therapy of HLA haploidentical peripheral blood stem cells transplantation. Methods: To analysis the factors effecting long term survival of refractory leukemia patients who underwent HLA haploidentical peripheral blood stem cells transplantation. The HLA mismatched locus between the donors and patients, the disease status of patients at transplant, the grafted mononucleaer cells number, and the occurrence of GVHD, the age of patients and other factors were considered and analyzed by data reduction SSP11. From July, 1998 to May, 2004, 30 Patients with refractory leukemia patients including 13 cases of acute non-lymphocytes leukemia, 10 cases of acute lymphocytes leukemia, 6 cases chronic myeloid leukemia and 1 cases of non-Hodgkin lymphoma underwent HLA haploidentical peripheral blood stem cells transplantations. The median age was 25 years old (3– 52 years old). Twelve patients received stem cells from parents, four from daughter and son, and the other from sibling donors. Twelve patients received three HLA locus mismatched stem cells, thirteen patients received two HLA mismatched donors stem cells, and five patients received one HLA mismatched donors stem cells. The conditioning regime consisted of fludara (25mg/m2 X5d), busufan (4mg/kg X4d) and cyclophosphamide ( 60mg/kg X2d). Median dose of rabbit anti-human lymphocyte globulin (5mg/kg X5d) was added in the in some patients. A mean of 6.0 x 108 /kg (3–9 x108 /kg) mono-nucleated cells was grafted. The mean CD34+ cells number was 5.5 x106 /Kg (3–6.5 x106/kg). Results: Twenty-nine patients were successfully grafted and one failed to graft. The mean time of white cell count more than 1x109/L was 13 days (10–18 days) and 12 days (9–16) respectively. Severe acute graft versus host disease occurred in six patients, and four died. Seven patients suffered from intensive chronic graft versus host disease. Nine patients relapsed and died. The mean relapse time was 10 months (3 months to 24 months). Four patients died from intensive chronic graft versus host disease. Fourteen patients are still disease free survival with high karnofsky performs. The relapse of leukemia was the main cause of death. Five the patients less than 20 year’s old age are still disease free survival with high karnofsky performs scores. Conclusion: HLA haploidentical peripheral blood stem cells transplantation may be an effect therapy for refractory leukemia. Although graft versus leukemia effect may be strong in HLA haploidentical blood stem cells transplantation, leukemia relapse is still the main cause to death. We suggest that for these patients with leukemia who can not find full matched donor perform related HLA mismatched peripheral blood stem cells transplantation as earlier as to get the better long term outcome.

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Pegfilgrastim after High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cells Transplantation. A Single-Centre Experience in 15 Patients.

Blood ◽

10.1182/blood.v104.11.4213.4213 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4213-4213 ◽

Cited By ~ 1

Author(s):

Carole Soussain ◽

Laure Marec ◽

Wajed Abarah ◽

Christian Allard ◽

Hassina Mallek ◽

...

Keyword(s):

Stem Cells ◽

Multiple Myeloma ◽

Peripheral Blood ◽

Central Nervous System Lymphoma ◽

High Dose Chemotherapy ◽

Fixed Dose ◽

High Dose ◽

Peripheral Blood Stem Cells ◽

Blood Stem Cells ◽

Stem Cells Transplantation

Abstract The efficacy of Pegfilgrastim (PF) in decreasing the duration of neutropenia has been proved after standard dose of chemotherapy. Results of PF after high dose chemotherapy (HDC) and autologous peripheral blood stem cells transplantation ASCT) are lacking. We studied the efficacy of PG in patients receiving HDC and ASCT for lymphoproliferative disease. Fifteen consecutive patients (8 males; 7 females) were onrolled in the study from September 2003 through March 2004. Median age of the patients was 56 years. Diseases were multiple myeloma in 5 patients, diffuse large cell non-Hodgkin’s lymphoma (NHL) in 3 patients, follicular lymphoma in 4 patients, mantle cell lymphoma in one patient, and primary central nervous system lymphoma PCNSL) in 2 patients. All patients were eligible for HDC and ASCT per institutional criteria. Stem cells were collected with peripheral blood pheresis after high dose cyclophosphamide (7 cases); high dose Ara-c (5 cases); ifosfamide (1 case); CHOP-like chemotherapy (1 case); or in steady state (1 case). All the patients received daily G-CSF (5 to 10 mcg/kg). Three different conditioning regimens were used. Patients with multiple myeloma received high dose melphalan (200 mg/m²), patients with PCNSL received a combination of high dose Thiotepa (750 mg/m²), Busulfan (12 mg/kg), and Cyclophosphamide (120 mg/kg), and patients with NHL received a BEAM chemotherapy. PF was administered as a single subcutaneous injection of 6 mg at day +3 after stem cell infusion, except for one patient whose injection was done on day 4. No adverse event attributable to PF was observed. There were no toxic death on study. All patients engrafted neutrophils and platelets. The median time to neutrophils engraftment (> 500/mm3) was 7 days (range, 4–12). Febrile neutropenia was almost constant (14/15) but never exceed OMS grade 2. Median number of days with IV antibiotics was 7 days (range 5–22). These preliminary data show that a fixed dose of 6 mg of PF given subcutaneously at day +3 after HDC and ASCT is safe and effective. A cost efficacy study is warranted to compare PF and daily dose of standard G-CSF after ASCT.

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