Korean J Intern Med.  2004 Dec;19(4):243-249.

Megadose CD34+ Hemopoietic Stem Cell Transplantation for Patients with High Risk Acute Myeloid Leukemia Who Have No HLA Matched Donor: A Pilot Study of a Full Haplotype Mismatch Transplantation

• Kim HJ
• Min WS
• Park YH
• Kim YJ
• Lee S
• Kim DW
• Lee JW
• Kim CC

Abstract

BACKGROUND
Haploidentical transplantation has become a popular modality of treatment for acute myeloid leukemia (AML) patients lacking donors with matching HLA. We attempted to assess the success rate and ramifications of full haplotype mismatch transplantation. METHODS: Four patients received stem cell transplantation from their full haplotype mismatched family donors. The conditioning regimen included total-body irradiation, intravenous busulfan, antithymocyte globulin, and fludarabine. Megadose CD34+ stem cell transplants were performed, in a dosage range between 10.9 X 10 (6) /kg and 20.6 X 10 (6) /kg. Neither GvHD prophylaxis nor post-transplant G-CSF were administered. We monitored patients' bone marrow cellularity and peripheral blood chimerism using real-time PCR. RESULTS: All patients evidenced stable engraftment. The most frequent side effect was severe mucositis, but all patients recovered successfully, without early death. No patients exhibited acute GvHD. Two refractory patients relapsed soon after transplantation. The other 2 patients have remained in good clinical condition, with a follow-up duration of 1~4 months. CONCLUSION: Using a newly-developed conditioning regimen, we were able to circumvent GvHD and graft failure, which are the main limitations associated with full haplotype mismatch transplantation. According to our analysis of the relevant literature, it appears that this is the first report of such a conditioning regimen.

Keyword

Full haplotype mismatch transplantation; High risk AML; GvHD; Graft failure

MeSH Terms

Adolescent
Adult
Antigens, CD34/*analysis
Female
Graft vs Host Disease/prevention & control
Histocompatibility
Humans
Leukemia, Myelocytic, Acute/*therapy
Male
Pilot Projects
Stem Cell Transplantation/*methods
Transplantation Conditioning/methods