Similar outcomes of allogeneic hematopoietic cell transplantation from unrelated donor and umbilical cord blood vs. sibling donor for pediatric acute myeloid leukemia: Multicenter experience in China

Abstract Objective To explore the feasibility, long-term hematopoiesis and complication of transplantation with two units of HLA-mismatched unrelated umbilical cord blood in treatment of adult acute myeloid leukemia. Methods A 32 years old, 50kg male with acute myeloid leukemia in complete remission received transplantation with two units of HLA-mismatched unrelated umbilical cord blood.The conditioning regimen were modified(BU/CY)+ATG. The prophylaxis regimen for graft versus-host disease(GVHD) consisted of cyclosporine(CSA) and mycophenolate mofetil(MMF). The umbilical cord blood obtained from two different donors, both with mismatched HLA B/DRB locus from the recipient and mismatched HLA- B locus between the two donors. The umbilical cord blood was preserved in liquid nitrogen, recovered in a 40o C water bath immediately, infused via a catheter from the femoral artery to the arc of aorta, The doses of nucleated cells infusion were 4.4×107/kg (from donor 1) and 2.8×107/kg (from donor 2). Results An absolute neutrophil count of more than 0.5×109/L at day 26,and a platelet count of more than 20×109/L at day 42. Septicemia with MRSA and pseudomomanas occurred at day 9 and day 14 because of agranulocytosis. The infection was controlled by Vancomycin, Tienam and HD-dose Gama immunoglobulin. Neither acute nor chronic GVHD developed in a follow-up period of 90 days. DNA-STR and HLA distinct analysis assay revealed a complete implant of cells from only one donor(donor2). Conclusions 1.No donor with matched HLA bone marrow stem cell was available for the adult patient at the time of his relapse. HLA mismatched umbilical cord blood was obtained from two donors. Although cell counts for transplantation are much lower than the requirement of routine bone marrow transplantation, the speed of blood cell regeneration in the recipient is compatible with routine bone marrow transplantation. 2.Furthermore, Although DNA-STR and HLA analysis indicate complete implant of cells from only one donor, the result indicates transplantation with umbilical cord blood cells obtained from two different donors is promising in the situation where the cell number obtained from one donor is not enough.3.HLA- B/DRB locus was mismatched in the two donors. GVHD did not develop even after tapered off immunosuppresents 3 months post transplantation. No cross rejection observed by clinical presentation and blood cell analysis. The results indicate the incidence of GVHD is low after umbilical cord blood transplantation.

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Successful transfer of umbilical cord blood CD34 + hematopoietic stem and progenitor-derived NK cells in older acute myeloid leukemia patients

Cytotherapy ◽

10.1016/j.jcyt.2017.03.021 ◽

2017 ◽

Vol 19 (5) ◽

pp. e5-e6

Author(s):

Jan Spanholtz ◽

Harry Dolstra ◽

Mieke Roeven ◽

Joop Jansen ◽

Gerwin Huls ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Cord Blood ◽

Nk Cells ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Myeloid Leukemia ◽

Hematopoietic Stem ◽

Cord Blood Cd34 ◽

Successful Transfer ◽

Acute Myeloid

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Total Body Irradiation without Chemotherapy as Conditioning for an Allogeneic Hematopoietic Cell Transplantation for Adult Acute Myeloid Leukemia

Case Reports in Hematology ◽

10.1155/2016/1257679 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Sultan Altouri ◽

Mitchell Sabloff ◽

David Allan ◽

Harry Atkins ◽

Lothar Huebsch ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Cell Transplantation ◽

Myeloid Leukemia ◽

Hematopoietic Cell Transplantation ◽

Chronic Gvhd ◽

Hematopoietic Cell ◽

Allogeneic Hematopoietic Cell Transplantation ◽

Unrelated Donor ◽

Relapsed Disease ◽

Acute Myeloid

Current therapies for acute myeloid leukemia (AML), failing induction, are rarely effective. We report our experience in 4 patients with AML who received 16 Gy TBI prior to allogeneic hematopoietic cell transplantation (alloHCT), between June 2010 and May 2011. Patients were 20 to 55 years of age, 2 with relapsed disease and 2 with AML failing induction. An HLA-matched graft from related or unrelated donor was infused on day 0. All but one, who received a CD34+-selected graft, received methotrexate and tacrolimus +/− antithymocyte globulin, as GVHD prophylaxis. The other patient received tacrolimus alone. Neutrophil and platelet engraftment occurred at a median of 18 and 14 days, respectively. Patients were discharged at a median of 28 days. There were no unexpected toxicities in the first 30 days. One patient had cytomegalovirus (CMV) viremia and anorexia, at two months. One patient had grade 2 acute GVHD of the skin. One patient developed chronic GVHD of the eyes, mouth, skin, joints, and lung at 4 months. Two patients died from relapse of their leukemia at days 65 and 125. Two patients remain in remission beyond day 1500. 16 Gy TBI followed by an alloHCT for AML, failing induction, is feasible and tolerable.

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