Ikegame Kazuhiro, Kaida Katsuji, Yoshihara Satoshi, Yoshihara Kyoko, Ishii Shinichi, Inoue Takayuki, Okada Masaya, Tamaki Hiroya, Soma Toshihiro, Kusunoki Yasushi, Kojima Hiroto, Saji Hiroh, Ogawa Hiroyasu
Division of Hematology, Department of Internal Medicine, Hyogo Medical College, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Transfusion Medicine and Cell Therapy, Hyogo Medical College, Nishinomiya, Hyogo, Japan.
Int J Hematol. 2017 May;105(5):646-657. doi: 10.1007/s12185-016-2168-y. Epub 2016 Dec 24.
We report a pilot series of five patients who received stem cell transplantation (SCT) from a spouse for post-transplant relapse or rejection. The inclusion criterion regarding HLA disparities was three or fewer antigen mismatches in the graft-versus-host direction at the HLA-A, B, and DR loci. Four patients received spousal SCT as a third transplant attempt after post-transplant relapse and one as rescue for graft rejection. The reduced intensity conditioning (RIC) regimen consisted of fludarabine, melphalan, and anti-thymocyte globulin (ATG) with 3 Gy of total body irradiation (TBI) for relapse cases and ATG plus 4 Gy of TBI for the rejection case. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus, methylprednisolone, and mycophenolate mofetil. Peripheral blood stem cells were transplanted. Granulocyte engraftment was achieved in all cases between days 9 and 11 (median, 10) with complete spousal chimerism. In three of the five patients, no acute GVHD was observed, while one case developed grade III GVHD and one case grade IV. All four patients evaluable for the anti-leukemic effect achieved complete remission; however, all relapsed between 106 and 334 day post-transplant, and died between days 152 and 548. We suggest that spousal SCT can be performed as a repetitive SCT using a RIC regimen with low-dose ATG and steroid-containing GVHD prophylaxis.
我们报告了一个由五名患者组成的试点系列，这些患者因移植后复发或排斥反应接受了来自配偶的干细胞移植（SCT）。关于HLA差异的纳入标准是在HLA - A、B和DR位点上，移植物抗宿主方向的抗原错配为三个或更少。四名患者在移植后复发后接受配偶SCT作为第三次移植尝试，一名患者接受配偶SCT以挽救移植排斥反应。低强度预处理（RIC）方案包括氟达拉滨、美法仑和抗胸腺细胞球蛋白（ATG），复发患者接受3 Gy全身照射（TBI），排斥反应患者接受ATG加4 Gy TBI。移植物抗宿主病（GVHD）预防包括他克莫司、甲基泼尼松龙和霉酚酸酯。移植的是外周血干细胞。所有病例在第9天至第11天（中位数为10天）实现了粒细胞植入，并伴有完全的配偶嵌合体。五名患者中有三名未观察到急性GVHD，一名患者发生了III级GVHD，一名患者发生了IV级GVHD。所有四名可评估抗白血病效果的患者均实现了完全缓解；然而，所有患者均在移植后106天至334天之间复发，并在第152天至548天之间死亡。我们建议配偶SCT可以作为重复SCT进行，采用含低剂量ATG和类固醇的GVHD预防的RIC方案。
