Journal
BONE MARROW TRANSPLANTATION
Volume 47, Issue 12, Pages 1507-1512Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/bmt.2012.79
Keywords
severe acquired aplastic anemia; unmanipulated haploidentical transplantation; unmanipulated haploidentical transplantation in SAA; HSCT in SAA
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Funding
- National Outstanding Young Scientist's Foundation of China [30725038]
- Special Research Fund of Health Program of Ministry of Health of China [200802027]
- National Natural Science Foundation of China [30725038]
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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. Bone Marrow Transplantation (2012) 47, 1507-1512; doi:10.1038/bmt.2012.79; published online 28 May 2012
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