Contributions
Abstract: PB2452
Type: Publication Only
Background
The haplo-identical HSCT is currently a rescue procedure in patients (pts) with high risk hematological malignancies when identical HLA donor is not available. This procedure without T-depletion appears to allow rapid immune reconstitution and reduced incidence of graft-versus-host disease (GVHD) and good survivals.
Aims
We propose a retrospective study of 35 pts who benefited from this procedure.
Methods
From May 2013 to January 2017, 36 haplo-identical HSCT were used in 35 pts with hematological malignancies (7 AML, 19 ALL, 5 CML in blast crisis, 1 lymphoblastic NHL, 2 AL biphenotypic, 1 MDS). Median age was 24 years (5-55) and sex-ratio (M/F):2.8. The diagnosis-transplant delay is 32 months (6-138). At the time of the transplant, 21 pts were in second complete remission and 5 pts in active disease. The donors used were parent (father: 17, mother: 3) or siblings (brother: 11, sister: 4) or offsprings (daughter 1). The median age for donors is 39 years (13 -65). The degree of compatibility (HLA A, B and DR) is 3/6 (24 cases), 4/6 (10 cases) and 5/6 (2 cases). CMV status between donor/recipient was high risk in 35 cases. The ABO incompatibility is major in 5 cases, minor in 4 cases. The conditioning regimen associated Busilvex 9.6 mg/kg; Aracytine 8 g/m2; Cyclophosphamide 3.6 g/m2 for all pts. The GVHD prophylaxis included the combination Ciclosporin-Methotrexate, Mycophenolate mofetil and Thymoglobulin (10 mg/kg) in 35 pts. Thirty-five pts received an unmanipulated bone marrow (BM) transplant and Peripheral blood stem cells (PBSC) with a median dose infused CD34+ cells: 8.89 106/kg (1.43-32), mononuclear cells: 7.67.108/kg (0.59-19.2), CD3+ cells: 2.99 108/kg (0.04-14.2), CD4+ cells: 1.62 108/kg ( 0.02-7.53), CD8+ cells: 1.46 108/kg (0.36-7.53). At September 2017, the minimal follow-up delay was 8 months and maximal 52 months.
Results
Aplasia was observed in all pts with median duration of 20 days (13-32). The median day of neutrophils engraftment was 13 days (11-27). No cases of VOD were observed. One pt presented an early rejection and benefited from a second haplo-identical transplant with another donor. Acute GVHD occurred in 17 pts (48%) including 14 (40%) grade II-IV. Chronic GVHD was seen in 11 pts (39%) with extensive form in 4 pts. Seventeen pts (43%) showed CMV reactivation on average at day 44 (35-67). Eight cases of haemorrhagic cystitis (22%) (one grade 4) are observed on average at day 47 (26-119). Nine pts (25%) relapsed, of which 5 pts were blast crisis at the time of the transplant. After follow-up of 15 months (8-52), 19 pts (54%) are alive and 16 pts (45%) died within 10 pts (28%) from TRM (GVHA digestive: 3, severe infection: 5, haemorrhagic cystitis: 1, TRALI syndrome: 1) and 6 pts from relapse. The overall survival (OS) and disease free survival (DFS) are 51.5% and 41.6% respectively.
Conclusion
Haplo-identical allograft is, currently, a well-validated procedure in pts with high-risk haematological malignancies who do not have sibling HLA donor as our results show. However GVHD, CMV reactivation and TRM are relatively high with this procedure using combination of primed BM and PBSC.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Bone Marrow, Haploidentical stem cell transplantation, Peripheral blood stem cell
Abstract: PB2452
Type: Publication Only
Background
The haplo-identical HSCT is currently a rescue procedure in patients (pts) with high risk hematological malignancies when identical HLA donor is not available. This procedure without T-depletion appears to allow rapid immune reconstitution and reduced incidence of graft-versus-host disease (GVHD) and good survivals.
Aims
We propose a retrospective study of 35 pts who benefited from this procedure.
Methods
From May 2013 to January 2017, 36 haplo-identical HSCT were used in 35 pts with hematological malignancies (7 AML, 19 ALL, 5 CML in blast crisis, 1 lymphoblastic NHL, 2 AL biphenotypic, 1 MDS). Median age was 24 years (5-55) and sex-ratio (M/F):2.8. The diagnosis-transplant delay is 32 months (6-138). At the time of the transplant, 21 pts were in second complete remission and 5 pts in active disease. The donors used were parent (father: 17, mother: 3) or siblings (brother: 11, sister: 4) or offsprings (daughter 1). The median age for donors is 39 years (13 -65). The degree of compatibility (HLA A, B and DR) is 3/6 (24 cases), 4/6 (10 cases) and 5/6 (2 cases). CMV status between donor/recipient was high risk in 35 cases. The ABO incompatibility is major in 5 cases, minor in 4 cases. The conditioning regimen associated Busilvex 9.6 mg/kg; Aracytine 8 g/m2; Cyclophosphamide 3.6 g/m2 for all pts. The GVHD prophylaxis included the combination Ciclosporin-Methotrexate, Mycophenolate mofetil and Thymoglobulin (10 mg/kg) in 35 pts. Thirty-five pts received an unmanipulated bone marrow (BM) transplant and Peripheral blood stem cells (PBSC) with a median dose infused CD34+ cells: 8.89 106/kg (1.43-32), mononuclear cells: 7.67.108/kg (0.59-19.2), CD3+ cells: 2.99 108/kg (0.04-14.2), CD4+ cells: 1.62 108/kg ( 0.02-7.53), CD8+ cells: 1.46 108/kg (0.36-7.53). At September 2017, the minimal follow-up delay was 8 months and maximal 52 months.
Results
Aplasia was observed in all pts with median duration of 20 days (13-32). The median day of neutrophils engraftment was 13 days (11-27). No cases of VOD were observed. One pt presented an early rejection and benefited from a second haplo-identical transplant with another donor. Acute GVHD occurred in 17 pts (48%) including 14 (40%) grade II-IV. Chronic GVHD was seen in 11 pts (39%) with extensive form in 4 pts. Seventeen pts (43%) showed CMV reactivation on average at day 44 (35-67). Eight cases of haemorrhagic cystitis (22%) (one grade 4) are observed on average at day 47 (26-119). Nine pts (25%) relapsed, of which 5 pts were blast crisis at the time of the transplant. After follow-up of 15 months (8-52), 19 pts (54%) are alive and 16 pts (45%) died within 10 pts (28%) from TRM (GVHA digestive: 3, severe infection: 5, haemorrhagic cystitis: 1, TRALI syndrome: 1) and 6 pts from relapse. The overall survival (OS) and disease free survival (DFS) are 51.5% and 41.6% respectively.
Conclusion
Haplo-identical allograft is, currently, a well-validated procedure in pts with high-risk haematological malignancies who do not have sibling HLA donor as our results show. However GVHD, CMV reactivation and TRM are relatively high with this procedure using combination of primed BM and PBSC.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Bone Marrow, Haploidentical stem cell transplantation, Peripheral blood stem cell