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International Journal of Hematology

, Volume 108, Issue 1, pp 76–84 | Cite as

T-cell-replete haploidentical stem cell transplantation using low-dose antithymocyte globulin in children with relapsed or refractory acute leukemia

  • Hideki Sano
  • Kazuhiro Mochizuki
  • Shogo Kobayashi
  • Yoshihiro Ohara
  • Masaki Ito
  • Tomoko Waragai
  • Nobuhisa Takahashi
  • Kazuhiko Ikeda
  • Hitoshi Ohto
  • Atsushi Kikuta
Original Article
  • 187 Downloads

Abstract

We evaluated the efficacy and toxicity of T-cell-replete haploidentical stem cell transplantation (TCR-haploSCT) using low-dose antithymocyte globulin (ATG) in children with refractory/relapsed (R/R) acute leukemia. From October 2009 to April 2016, 39 consecutive patients with R/R acute leukemia who underwent TCR-haploSCT were included. At the time of TCR-haploSCT, 17 patients were in complete remission (CR), but 22 had active disease. Thirty-three patients received a myeloablative regimen and six received a reduced-intensity conditioning regimen. Graft-versus-host disease (GvHD) prophylaxis comprised tacrolimus, methotrexate, prednisolone, and low-dose ATG (thymoglobulin 2.5 mg/kg). Neutrophil engraftment (> 0.5 × 109/L) was 95% after a median of 13 days. The median follow-up period was 527 days, with mean 3-year overall and disease-free survival rates of 45.1% [standard deviation (SD), ± 8.5%) and 33.8% (SD, ± 7.9%), respectively. The cumulative incidence of acute GvHD was 73.0%, but that of grade III–IV acute GvHD was 34.1%. The 3-year cumulative incidences of relapse and transplant-related mortality were 50.3 and 15.9%, respectively. Age < 10 years at transplantation was associated with a better overall survival in the multivariate analysis. These data suggest that TCR-haploSCT using a low-dose ATG combined with the GvHD prophylaxis described here has a significant anti-leukemic activity, particularly in younger patients.

Keywords

Acute leukemia Haploidentical hematopoietic stem cell transplantation Relapse Children Graft-versus-host disease 

Abbreviations

SCT

Stem cell transplantation

ATG

Antithymocyte globulin

R/R AL

Refractory/relapsed acute leukemia

TCR

T-cell-replete

GvHD

Graft-versus-host disease

GvL

Graft-versus-leukemia

PTCY

Post-transplantation cyclophosphamide

MLL

Mixed lineage leukemia

CMV

Cytomegalovirus

G-CSF

Granulocyte-colony stimulating factor

TRM

Transplant-related mortality

PBSCs

Peripheral blood stem cells

CR

Complete remission

FLT3-ITD

FMS like tyrosine kinase- internal tandem duplication

M/NKL

Myeloid natural killer cell precursor leukemia

ALL

Acute lymphoblastic leukemia

AML

Acute myeloid leukemia

HLA

Human leukocyte antigen

EBV

Epstein–Barr virus

SD

Standard deviation

Notes

Acknowledgements

We wish to thank all the clinicians and nurses who helped to support the care of patients in this study. We also thank the technicians at the Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, especially Mr. Satoshi Ono for his help with the HLA typing and Mr. Shunichi Saito for CD34+ and CD3+ cell assays. We would like to thank Editage (http://www.editage.ip) for English language editing.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

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Copyright information

© The Japanese Society of Hematology 2018

Authors and Affiliations

  • Hideki Sano
    • 1
  • Kazuhiro Mochizuki
    • 1
  • Shogo Kobayashi
    • 1
  • Yoshihiro Ohara
    • 1
  • Masaki Ito
    • 1
  • Tomoko Waragai
    • 1
  • Nobuhisa Takahashi
    • 1
  • Kazuhiko Ikeda
    • 2
  • Hitoshi Ohto
    • 2
  • Atsushi Kikuta
    • 1
  1. 1.Department of Pediatric OncologyFukushima Medical University HospitalFukushimaJapan
  2. 2.Department of Blood Transfusion and Transplantation ImmunologyFukushima Medical University HospitalFukushimaJapan

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