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Conditioning Regimens

A novel protocol for haploidentical hematopoietic SCT without in vitro T-cell depletion in the treatment of severe acquired aplastic anemia

Bone Marrow Transplantation volume 47, pages 1507–1512 (2012)Cite this article

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Abstract

Mismatched related donors of hematopoietic SCT (HSCT) for severe aplastic anemia (SAA) present challenges mainly associated with graft failure and GVHD. The greater the HLA disparity, the poorer the OS. About 19 consecutive SAA/very SAA (VSAA) patients who received HSCT from haploidentical family donors in our center are reported in this study, 18/19 pairs had 2–3 loci mismatched. All 19 cases failed to respond to previous therapy and were heavily transfused before transplantation. The conditioning regimen before HSCT included BU, CY and thymoglobulin. The recipients received CsA, mycophenolate mofetil (MMF) and short-term MTX for GVHD prophylaxis. The source of stem cell grafts was a combination of G-CSF-primed BM and G-CSF-mobilized peripheral blood stem cells. All patients achieved 100% donor myeloid engraftment; the median time for myeloid engraftment was 12 days (ranging from 10–29 days) and for platelets was 18 days (ranging from 8–180 days) with a cumulative platelet engraftment incidence of 84.21±10.53%. The cumulative incidence was 42.1±11.3% for grade II–IV acute GVHD and 56.2±12.4% for chronic GVHD. The OS was 64.6±12.4% with a median 746-day (90–1970) follow-up for surviving patients. These limited retrospective analysis data suggest that HLA-haploidentical HSCT for SAA patients without an HLA-identical sibling donor might be feasible. Further research to increase OS by decreasing GVHD while maintaining stable engraftment will be needed in the future.

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Acknowledgements

This work was supported (in part) by grants from the National Outstanding Young Scientist’s Foundation of China (No. 30725038), Special Research Fund of Health Program of Ministry of Health of China (No. 200802027) and National Natural Science Foundation of China (No. 30725038). We also acknowledge American Journal Experts (AJE) for editing the manuscript.

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  1. Department of Hematology, People’s Hospital and Institute of Hematology, Peking University, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, PR China

    L P Xu, K Y Liu, D H Liu, W Han, H Chen, Y H Chen, X H Zhang, Y Wang, F R Wang, J Z Wang & X J Huang

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  1. L P Xu
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Correspondence to X J Huang.

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Xu, L., Liu, K., Liu, D. et al. A novel protocol for haploidentical hematopoietic SCT without in vitro T-cell depletion in the treatment of severe acquired aplastic anemia. Bone Marrow Transplant 47, 1507–1512 (2012). https://doi.org/10.1038/bmt.2012.79

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