Hoshino Takumi, Takada Satoru, Hatsumi Nahoko, Sakura Toru
Leukemia Research Center, Saiseikai Maebashi Hospital, Kamishinden-machi, 564-1, Maebashi, Gunma, 371-0821, Japan.
Int J Hematol. 2019 Apr;109(4):463-469. doi: 10.1007/s12185-019-02610-4. Epub 2019 Feb 8.
Primary graft failure (PGF) is a lethal complication that occurs early after allogeneic stem cell transplantation (allo-SCT). Cord blood transplantation (CBT) is a potential re-transplantation option. Total body irradiation (TBI) is often incorporated into the pre-salvage CBT conditioning regimen following PGF; however, patients experiencing PGF are not always amenable to TBI, and non-TBI regimens for salvage CBT should be established. Here, we report five patients with hematologic malignancies who received salvage CBT for PGF following a non-TBI regimen using fludarabine (Flu), melphalan (Mel), and low-dose anti-thymocyte globulin (ATG). The median intervals between the failed allo-SCT and salvage CBT, as well as between the diagnosis of PGF and salvage CBT, were 37 days and 8 days, respectively. The median neutrophil recovery period was 21 days (range 18-21 days). Four of five patients achieved neutrophil engraftment following salvage CBT; all four exhibited sustained engraftment with complete donor chimerism. Three of the five patients were alive after a median follow-up time of 907 days (range 315-909 days) post-salvage CBT; two patients died of causes unrelated to recurrence. These data suggest that CBT following the non-TBI regimen described here is feasible in patients with PGF.
原发性移植物功能衰竭（PGF）是异基因干细胞移植（allo-SCT）后早期发生的一种致命并发症。脐血移植（CBT）是一种潜在的再次移植选择。全身照射（TBI）通常被纳入PGF后挽救性CBT预处理方案中；然而，发生PGF的患者并不总是适合接受TBI，因此应制定非TBI的挽救性CBT方案。在此，我们报告了5例血液系统恶性肿瘤患者，他们在接受使用氟达拉滨（Flu）、美法仑（Mel）和低剂量抗胸腺细胞球蛋白（ATG）的非TBI方案后，因PGF接受了挽救性CBT。初次allo-SCT失败与挽救性CBT之间以及PGF诊断与挽救性CBT之间的中位间隔分别为37天和8天。中性粒细胞恢复的中位时间为21天（范围18 - 21天）。5例患者中有4例在挽救性CBT后实现了中性粒细胞植入；所有4例均表现为持续植入且完全供体嵌合。5例患者中有3例在挽救性CBT后中位随访907天（范围315 - 909天）后存活；2例患者死于与复发无关的原因。这些数据表明，本文所述的非TBI方案后的CBT对PGF患者是可行的。
