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Haemopoietic Growth Factors

G-CSF-primed haploidentical marrow transplantation without ex vivo T cell depletion: an excellent alternative for high-risk leukemia

Bone Marrow Transplantation volume 30, pages 861–866 (2002)Cite this article

Abstract

Based on our encouraging results of G-CSF-primed HLA-matched related marrow transplants for high-risk leukemia, we extended the study from matched related to haploidentical transplants using G-CSF primed marrow and sequential immunosuppressants to prevent both graft-versus-host disease (GVHD) and host-versus-graft rejection (HVGR). Fifteen high-risk leukemia patients, who needed urgent transplantation but lacked an HLA-matched donor, underwent G-CSF-primed haploidentical marrow transplantation without ex vivo T cell depletion. Donors were given G-CSF (Lenograstim) at 3–4 μg/kg/day for 7 days prior to marrow harvest. GVHD and HVGR prophylaxis were combined in the sequential usage of cyclosporin A, methotrexate, anti-thymocyte globulin and mycophenolate mofetil. All patients established sustained trilineage engraftment at a median of 19 days and 21 days for neutrophil and platelets respectively. G-CSF priming significantly increased CD34+ and CFU-GM cells, reduced total lymphocytes and reversed the CD4+/CD8+ ratio in the donor marrow. The incidence of grade II–IV acute GVHD was 33.3%. Nine patients survived more than a year with a Karnofsky performance status of 100%. Estimated overall disease-free survival at 2 years was 60 ± 7%. In conclusion, using G-CSF priming marrow grafts along with sequential immunosuppressants provided an excellent alternative for the treatment of high-risk hematological malignancy in patients who lack matched donors.

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Authors and Affiliations

  1. Research Center for Hematology, The General Hospital of Air Force, PLA, Beijing, PR, China

    S-Q Ji, H-R Chen, H-X Wang, H-M Yan, L Zhu, J Liu & M Xue

  2. Division of Hematology/Oncology and Stem Cell Transplant Program, Department of Medicine, University of Kentucky, Lexington, KT, USA

    C-Q Xun

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  1. S-Q Ji
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  2. H-R Chen
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  7. M Xue
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  8. C-Q Xun
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Ji, SQ., Chen, HR., Wang, HX. et al. G-CSF-primed haploidentical marrow transplantation without ex vivo T cell depletion: an excellent alternative for high-risk leukemia. Bone Marrow Transplant 30, 861–866 (2002). https://doi.org/10.1038/sj.bmt.1703769

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