Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Safety of repeated un-manipulated peripheral blood stem cell haploidentical transplant for graft failure

Bone Marrow Transplantation volume 52, pages 157–158 (2017)Cite this article

Subjects

Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a curative therapeutic modality for patients with hematologic and non-hematologic illnesses. Despite the potential benefit, allo-HCT remains limited by complications including relapse, graft-versus-host disease (GVHD) and infection. Engraftment failure is another relatively uncommon complication of allo-HCT, but the incidence is increased with umbilical cord blood (UCB)1 and T-cell-depleted2 transplantation.

We describe our experience with salvage haploidentical (haplo) allo-HCT following graft failure of a myeloablative (MA) T-cell-replete peripheral blood stem cell (PBSC) HCT in three patients: one patient received HLA-mismatched, unrelated graft and two received haplo HCT. Subsequent to graft loss, all patients were salvaged with a non-myeloablative (NMA) T-cell-replete haplo HCT using a fludarabine (FLU), cyclophosphamide (CY) and total body irradiation (TBI) 4 Gy (FLU/CY/TBI-4 Gy) regimen. GVHD prophylaxis was post-transplant cyclophosphamide (PTCy) 50 mg/kg (days +3 and +4), tacrolimus (day +5 to +180) and mycophenolate mofetil (MMF) (day +5 to +35). This approach is similar to previously used NMA haplo HCT regimens except for the use of a higher-dose TBI of 4 Gy instead of 2 Gy.3

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Brunstein CG, Eapen M, Ahn KW, Appelbaum FR, Ballen KK, Champlin RE et al. Reduced-intensity conditioning transplantation in acute leukemia: the effect of source of unrelated donor stem cells on outcomes. Blood 2012; 119: 5591–5598.

    Article  CAS  Google Scholar 

  2. Rizzieri DA, Koh LP, Long GD, Gasparetto C, Sullivan KM, Horwitz M et al. Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution. J Clin Oncol 2007; 25: 690–697.

    Article  CAS  Google Scholar 

  3. Luznik L, O'Donnell PV, Symons HJ, Chen AR, Leffell MS, Zahurak M et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 2008; 14: 641–650.

    Article  CAS  Google Scholar 

  4. Brunstein CG, Fuchs EJ, Carter SL, Karanes C, Costa LJ, Wu J et al. Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts. Blood 2011; 118: 282–288.

    Article  CAS  Google Scholar 

  5. Kasamon YL, Bolanos-Meade J, Prince GT, Tsai HL, McCurdy SR, Kanakry JA et al. Outcomes of nonmyeloablative HLA-haploidentical blood or marrow transplantation with high-dose post-transplantation cyclophosphamide in older adults. J Clin Oncol 2015; 33: 3152–3161.

    Article  CAS  Google Scholar 

  6. Bacigalupo A, Dominietto A, Ghiso A, Di Grazia C, Lamparelli T, Gualandi F et al. Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update. Bone Marrow Transplant 2015; 50: S37–S39.

    Article  CAS  Google Scholar 

  7. Cieri N, Greco R, Crucitti L, Morelli M, Giglio F, Levati G et al. Post-transplantation cyclophosphamide and sirolimus after haploidentical hematopoietic stem cell transplantation using a treosulfan-based myeloablative conditioning and peripheral blood stem cells. Biol Blood Marrow Transplant 2015; 21: 1506–1514.

    Article  CAS  Google Scholar 

  8. Grosso D, Carabasi M, Filicko-O'Hara J, Kasner M, Wagner JL, Colombe B et al. A 2-step approach to myeloablative haploidentical stem cell transplantation: a phase 1/2 trial performed with optimized T-cell dosing. Blood 2011; 118: 4732–4739.

    Article  CAS  Google Scholar 

  9. Grosso D, Gaballa S, Alpdogan O, Carabasi M, Filicko-O'Hara J, Kasner M et al. A two-step approach to myeloablative haploidentical transplantation: low nonrelapse mortality and high survival confirmed in patients with earlier stage disease. Biol Blood Marrow Transplant 2015; 21: 646–652.

    Article  Google Scholar 

  10. Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK et al. Haploidentical transplantation using T cell replete peripheral blood stem cells and myeloablative conditioning in patients with high-risk hematologic malignancies who lack conventional donors is well tolerated and produces excellent relapse-free survival: results of a prospective phase II trial. Biol Blood Marrow Transplant 2012; 18: 1859–1866.

    Article  Google Scholar 

  11. Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK et al. Total body irradiation-based myeloablative haploidentical stem cell transplantation is a safe and effective alternative to unrelated donor transplantation in patients without matched sibling donors. Biol Blood Marrow Transplant 2015; 21: 1299–1307.

    Article  Google Scholar 

  12. Sugita J, Kawashima N, Fujisaki T, Kakihana K, Ota S, Matsuo K et al. HLA-haploidentical peripheral blood stem cell transplantation with post-transplant cyclophosphamide after busulfan-containing reduced-intensity conditioning. Biol Blood Marrow Transplant 2015; 21: 1646–1652.

    Article  Google Scholar 

  13. Schriber J, Agovi MA, Ho V, Ballen KK, Bacigalupo A, Lazarus HM et al. Second unrelated donor hematopoietic cell transplantation for primary graft failure. Biol Blood Marrow Transplant 2010; 16: 1099–1106.

    Article  Google Scholar 

  14. Tachibana T, Yamamoto E, Kawasaki R, Koharazawa H, Ishibashi D, Nakajima Y et al. Successful engraftment and durable graft-versus-host disease control with haploidentical peripheral blood and a short-term conditioning regimen for primary graft failure. Intern Med 2015; 54: 2749–2752.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Blood and Marrow Transplantation and Cellular Therapy Program, University of Alabama at Birmingham, Birmingham, AL, USA

    H Aboul Nour, A Di Stasi, D Salzman, R Innis-Shelton, L Lamb & A Saad

  2. Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    N Patil

  3. Pediatric Blood and Marrow Transplantation Program, University of Alabama at Birmingham, Birmingham, AL, USA

    J H Chewning

  4. Bone Marrow Transplant Program, Penn State Hershey Medical Center, Hershey, PA, USA

    S Mineishi

Authors
  1. H Aboul Nour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J H Chewning
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Di Stasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D Salzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Innis-Shelton
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L Lamb
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S Mineishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A Saad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Saad.

Ethics declarations

Competing interests

Ayman Saad discloses grant support from American Porphyria Foundation, research support from Astellas, and honoraria from Alexion and Spectrum Pharma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aboul Nour, H., Patil, N., Chewning, J. et al. Safety of repeated un-manipulated peripheral blood stem cell haploidentical transplant for graft failure. Bone Marrow Transplant 52, 157–158 (2017). https://doi.org/10.1038/bmt.2016.208

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2016.208

This article is cited by

Search

Advanced search

Quick links