Haploidentical bone marrow stem cell transplantation for hematological diseases: experience of single public Mexican hospital
Contact: Dr. Diego Cruz
Accepted 29 September 2016
Unavailability of complete HLA-matched related donors and lack of a bone marrow Registry in Mexico is one of our main problems when performing allogeneic stem cell transplantations (alloSCT) in the patients who require hematopoietic grafting. The aim of our work was to study haploidentical stem cell transplantation (haploSCT) as an alternative way for the patients lacking available stem cell donors.
Materials and methods
The study group included 20 patients (16 ALL, 1 SMD, 1 AML, 1 CML). Their median age was 30 (3-58) years old. Nine patients (45%) received reduced-intensity conditioning (RIC) regimens, and 11 (55%) received myeloablative conditioning (MAC) regimen. Bone marrow was used as a stem cell source. All the patients received high-dose cyclophosphamide (HDCY) on day +3 and +4, Tacrolimus and MMF as acute graft-versus-host-disease (aGVHD) prophylaxis.
Overall survival (OS) in both cohorts was 58% (OS rate was 60% for MAC cohort, with a median follow-up of 23.8 months, and 57% for RIC group, follow-up of 14 months). Two patients (18%) relapsed in each cohort. Two patients died from infectious complications in MAC cohort, whereas none of the patients was lost for these reasons in RIC cohort. Two (18%) patients from each group had grade IV aGVHD, but neither patient died from aGVHD. Median values for neutrophilic and platelet engraftment in RIC cohort was 15.3/27.8 days, respectively. Apрropriate values for MAC cohort were 19.4/30.7 days. All the patients from RIC cohort reached 100% chimerism as compared with 55% in MAC group.
HaploSCT is a feasible transplant mode which may be performed in Mexico for all patients with agressive malignant hematological diseases who have no an available donor.
1. Kanakry CG, Fuchs EJ, Luznik L. Modern approaches to HLA-haploidentical blood or marrow transplantation. Nat Rev Clin Oncol. 2016; 13(1):10–24
2. Luznik L, et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Transplant. 2008; 14(6):641–650.
High-dose cyclophosphamide, haploidentical stem cell transplantation