Haploidentical stem cell transplantation in adults for the treatment of hematologic diseases: results of a single center (CIC725)

Abstract

Allogeneic HSCT (allo-HSCT) is potentially curative option for a wide variety of malignant and nonmalignant disorders of hematopoiesis. For patients who lack an HLA-matched sibling, HLA-haploidentical related donors (haplo-HSCT) can be considered as alternative sources of donor graft s. Th e benefi ts of haplo-HSCT include immediate donor availability for patients who are in urgent need of the transplant. Besides, an availability of a related donor makes post-transplant donor-derived cellular therapy more easily accessible. In addition, the greater HLA mismatch associated with haploidentical HSCT (haplo-HSCT) may potentiate graft-versus-tumor (GVT) eff ects. Th e aim of our study was to summarize our single-center experience of haplo-HSCT performed with non-manipulated graft s in adult patients with different malignant diseases. Th e study included a total of 119 patients with diff erent hematological disorders subjected to haplo-HSCT. At the time of analysis, median follow-up was 371 days (1-2219). Most frequent diagnosis in transplanted patients was acute leukemia. 67 (56%) patients received haplo-HSCT as salvage therapy. Overall survival with an observation term of 2 years was 40.3% for the general group. In particular, the two-year OS in patients transplanted in remissions of ALL and AML was 57% and 46% respectively as compared to 22% and 15% for the patients transplanted in adverse disease status). Two-year event-free survival (EFS) and GVHD-free/relapse-free survival (GRFS) group proved to be 35.7% and 21% respectively. Th e cumulative incidence of acute GVHD grade II-IV and severe aGVHD grade III-IV was 19% and 10% respectively. Th e cumulative incidence of chronic GVHD (cGVHD) was 16%. Th e cumulative incidence of relapse was 21%. Th e overall transplant-associated mortality was 43% in the studied group. In conclusion, our results show that unmanipulated haplo-HSCT is reasonable treatment option for adult patients with diff erent malignant disorders of hematopoiesis. However, such problems as higher rate graft failure, increased nonrelapse mortality (NRM) and post-transplant relapses remain extremely relevant.

Extracorporeal Photopheresis in Children with Chronic Graft-Versus-Host Disease

“…In the present study, long-term OS (57%) and PFS (56%) were relatively high for this unfavorable group which predominantly comprised of high-risk patients. Relatively low level of CIR (23%) demonstrates fundamental opportunity of ECP to control SR cGVHD, without interfering in graft-versus-tumor effect [ 22 , 23 , 24 ]. The present study seems to be the first to demonstrate FFS in pediatric population treated with ECP.…”