PMID- 19167686
OWN - NLM
STAT- MEDLINE
DCOM- 20090406
LR  - 20220330
IS  - 1523-6536 (Electronic)
IS  - 1083-8791 (Linking)
VI  - 15
IP  - 2
DP  - 2009 Feb
TI  - Treatment of acute leukemia with unmanipulated HLA-mismatched/haploidentical 
      blood and bone marrow transplantation.
PG  - 257-65
LID - 10.1016/j.bbmt.2008.11.025 [doi]
AB  - Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains one of the 
      best therapeutic options to cure acute leukemia (AL). However, many patients have 
      no human leukocyte antigen (HLA)-matched donor. Recently, we developed a new 
      method for HLA-mismatched/haploidentical transplantation without in vitro T cell 
      depletion (TCD). This method combined granulocyte-colony stimulating factor 
      (G-CSF)-primed bone marrow and peripheral blood with intensive immunosuppression. 
      We analyzed the outcome of 250 consecutive patients with AL who underwent 
      HLA-mismatched/haploidentical transplantation with 1-3 mismatched loci of HLA-A, 
      B, and DR from family donors via our new transplant protocol. Two hundred 
      forty-nine patients achieved sustained, full donor chimerism. The incidence of 
      grade 2-4 acute graft-versus-host disease (aGVHD) was 45.8%, and that of grades 3 
      and 4 was 13.4%, which was not associated with the extent of HLA disparity. The 
      cumulative incidence of total chronic GVHD (cGVHD) was 53.9% and that of 
      extensive cGVHD was 22.6% in 217 evaluable patients. One hundred forty-one of the 
      250 patients survived free of disease recurrence at a median of 1092 days (range: 
      442-2437 days) of follow-up. Seventeen patients received DLI as a treatment for 
      relapse after transplantation and 7 patients achieved leukemia-free survival 
      (LFS). The 3-year probability of LFS for acute myelogenous leukemia (AML) was 
      70.7% and 55.9%, and for acute lymphoblastic leukemia (ALL) it was 59.7% and 
      24.8% in standard-risk and high-risk groups, respectively. Lower LFS were 
      associated with diagnosis of acute leukemia in the high-risk group (P= .001, 
      relative risk [RR], 95% confidence interval [CI]: 2.94[1.535-5.631]) and the 
      occurrence of aGVHD of grades 3 and 4 (P= .004). HLA-mismatched/haploidentical 
      HSCT was feasible with unmanipulated blood and bone marrow harvest.
FAU - Huang, Xiao-Jun
AU  - Huang XJ
AD  - Institute of Hematology, Peking University, Beijing, People's Republic of China. 
      xjhrm@medmail.com.cn
FAU - Liu, Dai-Hong
AU  - Liu DH
FAU - Liu, Kai-Yan
AU  - Liu KY
FAU - Xu, Lan-Ping
AU  - Xu LP
FAU - Chen, Huan
AU  - Chen H
FAU - Han, Wei
AU  - Han W
FAU - Chen, Yu-Hong
AU  - Chen YH
FAU - Zhang, Xiao-Hui
AU  - Zhang XH
FAU - Lu, Dao-Pei
AU  - Lu DP
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Biol Blood Marrow Transplant
JT  - Biology of blood and marrow transplantation : journal of the American Society for 
      Blood and Marrow Transplantation
JID - 9600628
RN  - 0 (HLA Antigens)
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Bone Marrow Transplantation/*methods
MH  - Child
MH  - Child, Preschool
MH  - Disease-Free Survival
MH  - Female
MH  - Graft vs Host Disease/immunology
MH  - HLA Antigens/*immunology
MH  - HLA-A Antigens
MH  - HLA-B Antigens
MH  - HLA-DR Antigens
MH  - Haplotypes/*immunology
MH  - Histocompatibility/*immunology
MH  - Humans
MH  - Leukemia/*therapy
MH  - Leukemia, Myeloid, Acute/mortality/therapy
MH  - Male
MH  - Middle Aged
MH  - Peripheral Blood Stem Cell Transplantation/*methods
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality/therapy
MH  - Transplantation, Homologous/immunology
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2009/01/27 09:00
MHDA- 2009/04/07 09:00
CRDT- 2009/01/27 09:00
PHST- 2008/08/25 00:00 [received]
PHST- 2008/11/14 00:00 [accepted]
PHST- 2009/01/27 09:00 [entrez]
PHST- 2009/01/27 09:00 [pubmed]
PHST- 2009/04/07 09:00 [medline]
AID - S1083-8791(08)00576-4 [pii]
AID - 10.1016/j.bbmt.2008.11.025 [doi]
PST - ppublish
SO  - Biol Blood Marrow Transplant. 2009 Feb;15(2):257-65. doi: 
      10.1016/j.bbmt.2008.11.025.