Work

105: A pilot study CD34 selected haploidentical transplant using a chemotherapy only preparative regimen and intensive antibiotic prophylaxis for treatment of advanced leukemia

Year: 2007

Type: article

Abstract: We present preliminary data of haploidentical transplant for 13 patients (pts) with acute leukemia using a chemotherapy-only preparative regimen of Melphalan 140 mg/m2 on day –8; Thiotepa 10 mg/kg on day –7; Fludarabine 40 mg/m2 on days –6, -5, -4, -3; 1.5 mg/kg of rabbit ATG/day days –6, -5, -4, -3.â device as a means of T-cell depletion. All products had <1 × 104 CD3+ T-cells/kg recipient body weight and needed a minimum of 5 × 106 CD34+ cells/kg but preferably >1 × 107 CD34+ cells/kg recipient body weight. Age ranged 23-50 years/median 37 years, four patients were in advanced remission and nine were in refractory relapse. Patients received intensive PCP prophylaxis with sulfamethoxazole-trimethoprim and pentamidine prior to transplant and during pancytopenia; CMV prophylaxis with valganciclovir during the BMT prep and foscarnet® while pancytopenic; and with liposomal amphotericin or cancidas for fungal prophylaxis. Two patients had primary graft failure-one survived disease free and one relapsed. One patient died of multiple organ failure prior to engraftment. Median time to engraftment was 15 days (range, 9-26) to 500 neutrophils and 14 days to platelets 20,000 (range, 13-25). Seven patients died of relapse at a median of 10 months (range 2-13 months), and one patient died of a viral infection. Two of 10 patients who engrafted developed grade one acute graft-versus-host (GVHD) and four patients had chronic GVHD (3 limited, 1 extensive). Four patients survive beyond 2 years, without recurrent disease. This report for haploidentical transplant demonstrates that a chemotherapy only preparative regimen can achieve a high rate of engraftment. Infectious complications were minimal with aggressive prophylaxis. Long-term remission are achievable with little risk of severe GVHD with t-cell depletion with use of CliniMACSâ in haploidentical stem cell transplant.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2006.12.109

Authors: J.L. Gajewski, J.D. McMannis, E.J. Shpall, M.L. Donato, R.E. Champlin

Institutions: Temple University, The University of Texas MD Anderson Cancer Center, Hackensack University Medical Center

Language: English

Topic: Hematopoietic Stem Cell Transplantation

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650