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Successful engraftment of HLA-haploidentical related transplants using nonmyeloablative conditioning with fludarabine, busulfan and anti-T-lymphocyte globulin

Leukemia volume 17, pages 2052–2054 (2003)Cite this article

TO THE EDITOR

To date, the feasibility of nonmyeloablative stem cell transplantation (NST) from a human leukocyte antigen (HLA)-matched sibling donor (MSD) has been reported by many investigators. However, the issue of whether NST from a partially mismatched related donor (PMRD) is also feasible for patients who lack an MSD remains to be determined. In the major histocompatibility complex nonidentical hematopoietic stem cell transplantation (SCT) setting, two immunological HLA barriers must be overcome. One is the rejection barrier, or host-versus-graft (HVG) reaction; the other is the graft-versus-host (GVH) reaction. In myeloablative transplant settings, the incidence of graft-versus-host disease (GVHD) or rejection has been reported to increase depending on HLA disparity in the GVH or HVG direction, respectively.1,2 For GVHD, myeloablative bone marrow transplantation (BMT) from a 1-antigen-mismatched related donor may be feasible depending on the patient's situation.3 Furthermore, successful transplantation from a 1-antigen-mismatched related donor using a reduced-intensity conditioning regimen has been reported recently.4 However, transplantation from donors with more than one antigen mismatch is not a generally accepted treatment option. On the other hand, with respect to rejection, recipients who undergo NST are in a considerably different situation than recipients who undergo myeloablative SCT. In NST settings, even if graft rejection occurs, recipient-type hematopoietic cells are expected to recover, and therefore rejection does not result in early death in most cases. Therefore, the fact that a donor has HLA mismatches of ⩾1 antigen in the HVG direction may not be a contraindication for NST.

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Acknowledgements

We thank Dr Hiroh Saji and Dr Etsuko Maruya, HLA Laboratory, NPO, Kyoto, for performing genomic HLA typing of donors and recipients, and Professor Emeritus Yoshihiro Tamaki, Oita Medical University, for his useful suggestion on chimerism analysis.

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  1. Department of Molecular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    H Tamaki, K Ikegame, M Kawakami, T Fujioka, A Tsuboi, Y Oka, I Kawase & H Ogawa

  2. Department of Clinical Laboratory Science, Osaka University Medical School, Osaka, Japan

    Y Oji & H Sugiyama

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Tamaki, H., Ikegame, K., Kawakami, M. et al. Successful engraftment of HLA-haploidentical related transplants using nonmyeloablative conditioning with fludarabine, busulfan and anti-T-lymphocyte globulin. Leukemia 17, 2052–2054 (2003). https://doi.org/10.1038/sj.leu.2403092

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