Comparison of Haploidentical Bone Marrow versus Matched Unrelated Donor Peripheral Blood Stem Cell Transplantation with Posttransplant Cyclophosphamide in Patients with Acute Leukemia

2020 ◽  
Author(s):  
Arnon Nagler ◽  
Myriam Labopin ◽  
Bhagirathbhai Dholaria ◽  
Emanuele Angelucci ◽  
Boris Afanasyev ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Unrelated Donor ◽  
Matched Unrelated Donor ◽  
Blood Stem Cell Transplantation

scholarly journals Unmanipulated Peripheral Blood Stem Cell Transplantation with non-TBI Myeloablative Conditioning Regimen from Haploidentical and Unrelated versus Related Donors for Acute Leukemia in Children, Adolescents and Young Adults (CAYA): A Competing Risk Analysis

2021 ◽  
Author(s):  
Seied Asadollah Mousavi ◽  
Tahereh Rostami ◽  
Azadeh Kiumarsi ◽  
Amir Kasaeian ◽  
Mohammadreza Rostami ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Conditioning Regimen ◽  
Unrelated Donor ◽  
Unrelated Donors ◽  
Blood Stem Cell Transplantation

Abstract BackgroundAllogeneic hematopoietic stem cell transplantation (HSCT) is the only potentially curative treatment for acute leukemia. Many different parameters have significant impact on the final results of HSCT such as donor type, stem cell source, and the implemented conditioning regimen. In the absence of an HLA-matched related donor, unrelated donors or haploidentical donors are possible alternatives for patients with an indication to HSCT. In order to compare the outcomes of HSCT from different donor types, in this single-center study, using a radiation-free MAC regimen, we compared the results of unmanipulated peripheral blood stem cell transplantation (PBSCT) from matched and mismatched related and unrelated donors with haploidentical donors in the children, adolescents and young adults (CAYA) affected by acute leukemia.MethodsIn this retrospective study, since 2014 to 2021, the outcome of CAYA patients with acute leukemia who had undergone peripheral blood T cell-replete HSCT from haploidentical donors versus unrelated donors (including 10/10 or 9/10 HLA-matched) versus related donors (including 10/10 or 9/10 HLA-matched) were evaluated. The HSCT was based on a radiation-free MAC regimen including Busulfan and Cyclophosphamide. The GvHD prophylaxis was based on the administration of Cyclosporine A in all patients, plus rabbit anti-human thymocytes globulins in unrelated and haploidentical donors and post transplantation cyclophosphamide in haploidentical donors. Adjusted multivariable proportional hazard Cox and competing risk analyses were performed.ResultsMedian follow up time was 28.7 months (95% CI: 21.9-34.9). Three-year overall survival rate (OS) and GvHD-free/relapse-free survival (GFRFS) rate was 68.81% (95% CI: 60.08%-76.01%) and 44.19% (95% CI: 35.52%-52.49%), respectively. Patients who had undergone HSCT from an unrelated donor had the lowest OS and GFRFS compared to other donor types. The 3-years NRM in all patients was 7.84% (95% CI 4.36-12.62). Adjusted multivariable modeling of OS showed that the hazard of death in patients who had undergone HSCT from an unrelated donor, was 3.6 times more than patients who underwent HSCT from their haploidentical donors (P=0.05). Likewise, the hazard of NRM after HSCT from unrelated donors was 6 times more than haploidentical donors (P=0.002). However, the relapse incidence was not significantly different between the two mentioned groups.ConclusionsIn this study, HSCT from haploidentical donors was associated with superior survival rates compared to HSCT from unrelated donors. So haploidentical peripheral blood derived HSCT could be a practical and valuable clinical option that offers CAYA patients with acute leukemia needing HSCT and lacking matched available donors, a reasonable opportunity for disease control.

Whole Blood Tissue Factor Procoagulant Activity Remains Detectable during Severe Aplasia following Bone Marrow and Peripheral Blood Stem Cell Transplantation

2001 ◽  
Vol 85 (02) ◽  
pp. 250-255 ◽  
Author(s):  
Muhit Ozcan ◽  
Colleen Morton ◽  
Anna Solovey ◽  
Luke Dandelet ◽  
Ronald Bach ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Endothelial Cells ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Tissue Factor ◽  
Cell Transplantation ◽  
Whole Blood ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Blood Stem Cell Transplantation

SummaryUsing a novel whole blood assay, we recently demonstrated that tissue factor procoagulant activity (TF PCA) is present in normal individuals. Preliminary experiments suggested that this activity is localized in the mononuclear cell fraction. Postulating that whole blood TF PCA would therefore be undetectable when monocytes and neutrophils are absent from peripheral blood, we assayed TF PCA during the peri-transplant period in 15 consecutive patients undergoing allogeneic (n = 12) or autologous (n = 3) bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT). Baseline (pre-transplant) mean TF PCA was higher in patients compared to normal controls (P <0.005). Unexpectedly, although TF PCA during the period of profound aplasia was significantly reduced compared to baseline (p <0.05), fully 55% of the initial activity remained detectable. During the engraftment phase, TF PCA returned to pre-transplant levels, with a linear correlation between monocyte counts and TF PCA (r = 0.63). In contrast to normal whole blood, incubation of aplastic samples with E. Coli lipopolysaccharide ex vivo failed to induce TF PCA. Throughout the period of study – but especially during the aplastic phase – the absolute number of circulating endothelial cells (CECs) that were TF antigen-positive was increased compared to normals (P <0.001). However, removal of these cells from whole blood samples failed to significantly diminish total TF PCA indicating that CECs alone could not account for the detectable TF PCA during aplasia. We conclude that neither circulating mature myelo-monocytic cells nor endothelial cells can account for all the functionally intact TF in peripheral blood. Further studies are needed to identify the other source(s) of TF PCA.

Comparative Analysis of Outcomes of Allogeneic Peripheral Blood Stem Cell Transplantation From Related and Unrelated Donors for Adults with Hematologic Malignancies

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2302-2302
Author(s):  
Chunji Gao ◽  
Xiaohong Li ◽  
Honghua Li ◽  
Wenrong Huang ◽  
Xiaoxiong Wu ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Hematologic Malignancies ◽  
Blood Stem Cell ◽  
Unrelated Donor ◽  
Gvhd Prophylaxis ◽  
Blood Stem Cell Transplantation

Abstract Abstract 2302 Although allogeneic peripheral blood stem cell transplantation from a matched related donor (RD-PBSCT) presents the best curable opportunity for many patients with hematologic malignancies, only about one third of individuals have HLA matched sibling donors. Fortunately, from unrelated donor peripheral blood stem cell transplantation has been acceptable and expanded recently. In order to evaluate the effect of allogeneic peripheral blood stem cell transplantation from unrelated donor (URD-PBSCT), we compare results of URD-PBSCT and RD-PBSCT that were done for 172 consecutive adult patients with hematologic maligancies from Jan 2002 to Dec 2008 at a single-center. Among these patients, 62 cases underwent URD-PBSCT and 110 cases underwent RD-PBSCT. Myeloablative conditioning was adopted for all patients. In graft versus host disease (GVHD) prophylaxis, 49 URD-PBSCT recipients received CSA, MTX, MMF and ATG (URD-ATG group), 13 recipients were given simulect more in base of URD-ATG group (URD-ATG+CD25 group) while RD-PBSCT recipients (RD group) received CSA, MTX and MMF. Engraftment was achieved in 98.4% of URD-PBSCT patients and 98.2% of RD-PBSCT patients (100% for patients surviving beyond 28 days after transplant). The cumulative incidence of acute GVHD (grade II-IV) was 15.4%, 36.7% and 29.1% respectively in the URD-ATG+CD25, URD-ATG and RD groups (P = 0.275). The cumulative incidence of chronic GVHD was 0%, 45.6%, 39.6% respectively and significant lower in URD-ATG+CD25 group than the other two groups (P = 0.0134). Relapse incidence was 53.8%, 12.2%, 14.5% respectively and significant higher in URD-ATG+CD25 group than the other s (P = 0.0059), while there was no different between the URD-ATG and RD groups (P = 0.610). Estimated overall survival (OS) at 5 years was 30.8%, 69.4% and 67.3% respectively and no significant difference between URD-ATG group and RD group (p=0.898). Adverse prognosis factors for relapse and OS included transplant not in remission and GVHD prophylaxis with simulect. Our results indicate PBSCT from unrelated donor may be considered comparable to those from related donor. Disclosures: No relevant conflicts of interest to declare.

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