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ctt-journal > Paina et al. (Abstract)

Paina et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract54
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation", Saint Petersburg, Russia, September 18–20, 2010

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The efficacy of haplo-HSCT in high-risk patients with hematological malignancies. A single centre experience

Olesya V. Paina, Elena V. Babenko, Alla A. Golovacheva, Alexander L. Alyanskiy, Natalia E. Ivanova, Natalia V. Stancheva, Elena V. Semenova, Ludmila S. Zubarovskaya, Boris V. Afanasyev

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russia

Correspondence: Olesya V. Paina, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantology, Saint-Petersburg Pavlov State Medical University, 6/8, Tolstoy str., Saint-Petersburg, 199044, Russia, E-mail: paina@spam is badmail.ru


Introduction: Haplo-HSCT is a treatment option for the approximately 70% of pts who don’t have an HLA-identical sibling donor. The principal causes limiting the use of haplo-HSCT are infectious complication, severe GVHD following T cell-replete SCT, graft failure, and recurrent malignancy after T cell-depleted SCT.

Aim: To investigate the efficiency of haplo-HSCT with and without the use of partial CD34+ cell selection in patients with high-risk hematological malignancies.

Methods: Forty pts were included in the study. Thirty-three were children and adolescents (1–21 yrs): 11 pts in 2 or > remission (5 ALL pts, 5 AML pts, and 1 Ewing’s sarcoma pt), and 22 pts in relapse or advanced disease (12 ALL pts, 7 AML pts, 1 AA pt, 1 CML ac. Phase pt, and 1 Neuroblastoma pt). Seven were adult pts (21–46 yrs): 1 pt in 2 or > remission-AML, and 6 pts in relapse or advanced disease (3 ALL pts , 2 AML pts, and 1 NHL pt). The conditioning regimen used was MAC for 14 pts (AraC-Bu-Cy-CCNU-ATG) and RIC (17 pts Flu-Bu-ATG; 3 pts Flu-Tio-Melph; 4 pts other) for the remaining 26. Prophylaxis for aGVHD was CsA-base for 28 pts, and 12 pts received Tacro-base prophylaxis. The cell source was G-CSF stimulated unmanipulated BM in 3 pts; and G-CSF stimulated BM+ PBSC CD34+ cells in 37 pts. PBSC CD34+ cells were selected using the CliniMACS device (Miltenyi Biotec). The total quantity of PBSC+BM CD 34+ cells infused into the recipient was 11.5x106/kg.

Results: Engraftment and full donor chimerism were achieved at D+60 in 28 pts (70%), and primary graft failure was diagnosed in 12 pts (30%), despite the high-risk aspects of this group. One-year OS for all treated patients was 45%. For pts who were transplanted in CR2> 1-yr OS was 50% and for relapse or advanced disease it was 42.9%. For ALL pts 1-yr OS was 55% (60% for CR2> and 23.3% for relapsed or advanced-stage pts). One-yr OS for AML pts was 33.3% (50% for CR2> and 22.2% for relapsed or advanced-stage pts). In pts who achieved full donor chimerism on D+60, 1-y OS was 53.6%, and for pts who did not achieve donor chimerism it was 25% (p<0.01).

Conclusions: Haplo-HCST prolongs OS in patients with high-risk hematological malignancies and possibly carries out an immunoadoptive therapeutical role, which, possibly, is as effective as AML and ALL.

Keywords: Haplo-HSCT, T cell-replete SCT, T cell-depleted SCT, graft failure, relapse


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