Haploidentical Stem Cell Transplantation (SCT) Using Flamsa Regimen As Salvage Chemotherapy

Yuksel M. K., Gokmen A., Ozcan M., Arslan O., Ilhan O., Ozbek D., ...Daha Fazla

BLOOD, cilt.124, sa.21, ss.5925, 2014 (SCI-Expanded)

  • Yayın Türü: Makale / Özet
  • Cilt numarası: 124 Sayı: 21
  • Basım Tarihi: 2014
  • Doi Numarası: 10.1182/blood.v124.21.5925.5925
  • Dergi Adı: BLOOD
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.5925
  • Ankara Üniversitesi Adresli: Evet

Özet

Abstract Haploidentical donors are alternative stem cell sources for the patients without matched related and unrelated donors. Finding a full match unrelated donor takes at least 6 months. Most of the patients who have advanced acute leukemia die during this period. Unfortunately, they also loose the chance of haploidentical stem cell transplantation (SCT). Aim: To report the outcome of six patients whom underwent haploidentical stem cell transplantation using FLAMSA regimen as initial reduction of leukemic burden. Patients and Treatment: There were six patients (F/M: 3/3) who admitted to transplantation unit between November 2012 and December 2013. Table 1 shows the characteristics of patients. Patients received fludarabine 30mg/m2, ARA-C 2gm/m2, Amsacrine 100 mg/m2 (FLAMSA) consequently 4 days before the intiation of conditioning protocol. According to the conditioning protocol number of the rest days changed (Table 2). For transplantation G-CSF mobilized peripheral blood stem cells were used. No graft manipulation was performed, 5x10e6 CD34+ cells/kg were requested. Graft versus host disease (GVHD) prophylaxis: Cyclophosphamide 50mg/kg/day (+3,+4), Tacrolimus 0.03 mg/kg/day +5 and MMF 3x15mg/kg +6 was started. In the absence of GVHD, MMF was discontinued by day +30, tacrolimus was tapered from day +60 to +100. Results: All of the patients had active diseases. Three of the six patients died during conditioning. Transplantation related mortality (TRM) was 50%. The other three patients were alive on the day 100. Overall survive (OS) on day 100 was %50. Two patients (22%) lived beyond 6 months. Of these two, one of them has completed the first year (16%) and is still alive without GVHD or disease relaps. Outcome of the patients are shown in Table 2. Discussion: The patient number is so restricted to draw any conclusions from this report but we know that Allogeneic SCT is the most effective treatment for a variety of hematologic malignancies. The current data suggest that the chosen sequential strategy of intensive chemotherapy followed after a few days of rest by allogeneic SCT has encourging results. Combining this modality with haploidentical transplantation may represent a step forward in the treatment of refractory hematologic malignancies. Table1: Patients’ and donors’ characteristics Patient no Gender Patient Age Diagnosis Tx no PRA Donor Donor age 1 M 37 ALL 1st Neg Brother 44 2 F 47 ALL 1st Neg Son 23 3 F 44 AML 1st Neg Son 22 4 M 41 AML 3rd(2MSD) Neg Mother 65 5 F 26 AML 2nd(1MUD) Neg Mother 54 6 F 46 ALL 2nd(1MSD) Neg Sister 53 M: Male F: Female ALL: Acute lymphoblastic leukemia, AML: Acute myeloblastic leukemia, Tx no: Number of transplantation, PRA: Panel Reactive Antibody, Neg: Negative MS:Match Sibling Donor, MUD Match Unrelated Donor) Abstract 5925 Table 2: Patients’ outcome Patient no Conditioning regimen Rest day (s) after FLAMSA Engraftment PLT 20/ NEU0.5 Chimerism on day 30 Engraftment failure Reinfusion of peripheral blood CD34+ GVHD Grade 3-4 Comorbid condition Status after SCT 1 MEL50mg/m2/day (-5,-4) TBI Gy (-3,-2,-1) -6 Yes Full Yes +105.day Yes No Exitus +210 day GVHD 2 MEL50mg/m2/day (-5,-4) TBI 4Gy(-3,-2,-1) -6 Yes Full No No No No Alive +390day 3 MEL 200mg/m2 (-1) -3,-2 No - - - - IPA Exitus+14day Gram negative septicemia 4 BU 3.2mg/kg/day (-5,-4,-3,-2) MEL 140mg/m2/day (-1) -9,-8,-7,-6 No - - - - IPA Exitus+12day Candidemi 5 MEL 200mg/m2 (-1) -3,-2 Yes Full Yes +125day No IPA Alive +240 day 6 BU 3.2mg/kg/day (-5,-4,-3,-2) MEL 140mg/m2/day (-1) -9,-8,-7,-6 No - - NA Panniculitis IPA Exitus day 0 BU: Busulfan, Mel: Melfelan, TBI: Total Body Irradiation, PLT 20: Platelet > 20.000 NEU 0.5: Neutrophil>500, GVHD: Graft versus Host Disease, IPA: Invasive Pulmonary Aspergillozis, Disclosures No relevant conflicts of interest to declare.