347 Reduced Intensity Transplants Using G-CSF-Mobilized Hemopoietic CELLS From Haploidentical Related Donors

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Kenneth Bradstock, BSc MB BS PhD , BMT Service, Westmead Hospital, Sydney, Australia
John Kwan, MB BS FRACP FRCPA , Haematology, Westmead Hospital, Sydney, Australia
Kenneth Micklethwaite, MBBS, BSc, PhD, FRACP, FRCPA , Haematology, Westmead Hospital, Westmead, ., Australia
David Gottlieb, MD PhD , Department of Medicine, Westmead Hospital, University of Sydney, Sydney NSW, ., Australia
Emily Blyth, MB BS PHD FRACP , Haematology, Westmead Hospital, Sydney, Australia
Gillian Huang , Haematology Clincal Trials Office, Westmead Hospital, Westmead, NSW, Australia
Stephanie Deren, RN , Haematology, Westmead Hospital, Sydney, Australia
Mark Hertzberg, MBBS PhD FRACP FRCPA , Department of Haematology, Westmead Hospital, Westmead, ., Australia
Aim

To determine the safety and feasibility of using G-CSF-mobilized peripheral blood progenitor cells from haploidentical related donors for transplantation in patients with poor-risk hematological malignancies receiving reduced intensity conditioning therapy and post-transplant cyclophosphamide as GVHD prophylaxis.

Methods

Nine  patients aged 33 to 65 years (median 48) with poor prognosis hematological malignancies (4 AML, 1 MDS, 2 Ph+ ALL, 1 DLBCL, 1 ALL) who lacked HLA-matched related or unrelated donors underwent transplantation using G-CSF-mobilized PBSC from haploidentical relatives, after receiving reduced intensity conditioning therapy with fludarabine, cyclophosphamide, and single fraction TBI 200 cGy. GVHD prophylaxis consisted of cyclophosphamide 50 mg/kg IV daily on days +3 and +4, followed by daily oral tacrolimus and mycophenolate. Median follow-up is 11 months (1-14). Results were compared with a previous cohort of 12 patients receiving unmanipulated haploidentical bone marrow

Results

Neutrophil and platelet recovery (ANC >1.0 median day 18, range 11-35 ; platelets >20 median day 19, 1-45) was comparable with 15 and 17 days respectively,for bone marrow. Six patients had neutropenic fevers, but there was no mucositis,  use of TPN, or early transplant-related death. Six of 8 assessable patients had complete donor chimerism in blood T cells and granulocytes at day +28. Two had graft rejection with only host DNA  (one patient with MDS with high-titre anti-donor HLA antibodies, and one patient with ALL), as compared with 2 rejections of 12 previous patients receiving bone marrow grafts. Of  the 6 patients with complete donor chimerism, 1 had stage 3 skin acute GVHD, but there has been  no chronic GVHD or disease relapse. The MDS patient with graft rejection was re-transplanted after plasmapheresis and rituximab and IV cyclophosphamide/busulphan conditioning with PBSC from an alternative haploidentical related donor, and identical GVHD prophylaxis, and achieved complete donor chimerism.

Conclusion

The use of unmanipulated G-CSF-mobilized HPC collected from haploidentical relatives appears feasible for patients receiving reduced intensity conditioning and high-dose cyclophosphamide as GVHD prophylaxis, with rates of engraftment, graft rejection and GHVD comparable to that seen with haploidentical bone marrow. This protocol offers an allogeneic transplant option with low cost and toxicity for patients without a HLA-identical donor.

See more of: Poster Session 2: Allogeneic Transplants
See more of: Contributed Abstracts
<< Previous Abstract | Next Abstract >>