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:

Longer delay of hematological recovery and increased transfusion needs after haploidentical compared to non-haploidentical stem cell transplantation

Bone Marrow Transplantation volume 51, pages 1150–1152 (2016)Cite this article

Subjects

Allogeneic stem cell transplantation (ASCT) remains a major therapeutic modality in many high-risk hematological diseases.1, 2, 3, 4, 5 With the improvement of conditioning chemotherapy and supportive care, the outcome of this strategy has improved.6 Yet a major issue remains, which is the quest for a fully-matched donor. Current strategies usually consist in selecting a matched related donor and, if not available, a matched unrelated donor. When this is not fruitful, choices move down to partially-matched (9/10e) unrelated donors or umbilical cord blood units.7 Although this strategy is likely to identify a graft, for some patients, finding a suitable donor is not possible. For the past few years, ASCT using family donors with only one identical HLA haplotype, also known as haploidentical ASCT (H-ASCT)8, 9, 10, 11, 12, 13 has helped to circumvent this hindrance, allowing us to propose ASCT to most patients. Yet this strategy involves increased toxicities such as GvHD and higher graft failure.14, 15 This led to highly immunosuppressive conditioning and immediate post-transplant strategies based partly on the use of post-transplantation cyclophosphamide (PTCY).11, 14 Little is known about the impact of this aggressive strategy in terms of hematological recovery, transfusion needs and infection risks. Here, we report early hematological recovery in a paired cohort of 44 patients, half of them having received H-ASCT.

This single-center study performed between May 2011 and June 2015 enrolled 22 patients with T-replete H-ASCT and 22 matched patients with a non-haploidentical ASCT (NH-ASCT) grafted during the same period. Patients were paired by age (51.2 years old in the H-ASCT group versus 50.9 years old in the NH-ASCT group, P=NS) and initial disease (6 acute myeloid leukemias, 9 acute lymphoblastic leukemias, 3 myelodysplastic syndromes, 3 non-Hodgkin’s lymphomas and 1 myelofibrosis in each group). Both groups were also similar in terms of gender (50% versus 73% males, P=NS), previous transplantation (36% versus 9%, P=NS), disease status at transplantation (complete response: 73% versus 68%, P=NS), dose of CD34+ cells infused (7.7±0.7 × 106 versus 6.3±0.6 × 106/kg, P=NS). All grafts were of PBSC (Table 1). In the H-ASCT group, all patients but three received a reduced-intensity conditioning (RIC). The latter three received a sequential regimen. All H-ASCT patients received 50 mg/kg of cyclophosphamide on days 3 and 4 post transplant. Three patients received G-CSF post transplant until hematological recovery. Three patients also received EPO (n=2) and/or TPO (n=2). In the NH-ASCT group, 6 patients received a myeloablative conditioning, 14 a RIC and 2 a sequential conditioning regimen. Clofarabine-containing RIC was administered in respectively 32% of the H-ASCT and 14% of the NH-ASCT patients (P=NS). In this subgroup, two patients also received G-CSF until hematological recovery, but none were given EPO nor TPO. In the NH-ASCT group, there were 12 familial and 10 matched unrelated donors. Donors and recipients were gender-matched in 55% of H-ASCT and in 87% of NH-ASCT (Table 1).

Table 1 Patients characteristics
Full size table

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. Brissot E, Mohty M . Which acute myeloid leukemia patients should be offered transplantation? Semin Hematol 2015; 52: 223–231.

    Article  Google Scholar 

  2. Oran B . Which patients should undergo allogeneic stem cell transplantation for myelodysplastic syndromes, and when should we do it? Clin Lymphoma Myeloma Leuk 2015; 15: S43–S49.

    Article  Google Scholar 

  3. Barrett AJ, Ito S . The role of stem cell transplantation for chronic myelogenous leukemia in the 21st century. Blood 2015; 125: 3230–3235.

    Article  CAS  Google Scholar 

  4. Bhatt VR, Vose JM . Hematopoietic stem cell transplantation for non-Hodgkin lymphoma. Hematol Oncol Clin North Am 2014; 28: 1073–1095.

    Article  Google Scholar 

  5. Lussana F, Rambaldi A, Finazzi MC, van Biezen A, Scholten M, Oldani E et al. Allogeneic hematopoietic stem cell transplantation in patients with polycythemia vera or essential thrombocythemia transformed to myelofibrosis or acute myeloid leukemia: a report from the MPN Subcommittee of the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2014; 99: 916–921.

    Article  Google Scholar 

  6. Thomson KJ, Peggs KS . Allogeneic transplantation in the UK: an aggregation of marginal gains? Br J Haematol 2013; 163: 149–159.

    PubMed  Google Scholar 

  7. Kekre N, Antin JH . Hematopoietic stem cell transplantation donor sources in the 21st century: choosing the ideal donor when a perfect match does not exist. Blood 2014; 124: 334–343.

    Article  CAS  Google Scholar 

  8. Aversa F, Tabilio A, Terenzi A, Velardi A, Falzetti F, Giannoni C et al. Successful engraftment of T-cell-depleted haploidentical ‘three-loci’ incompatible transplants in leukemia patients by addition of recombinant human granulocyte colony-stimulating factor-mobilized peripheral blood progenitor cells to bone marrow inoculum. Blood 1994; 84: 3948–3955.

    CAS  Google Scholar 

  9. Aversa F . Haploidentical haematopoietic stem cell transplantation for acute leukaemia in adults: experience in Europe and the United States. Bone Marrow Transplant 2008; 41: 473–481.

    Article  CAS  Google Scholar 

  10. Ballen KK, Spitzer TR . The great debate: haploidentical or cord blood transplant. Bone Marrow Transplant 2011; 46: 323–329.

    Article  CAS  Google Scholar 

  11. Di Bartolomeo P, Santarone S, De Angelis G, Picardi A, Cudillo L, Cerretti R et al. Haploidentical, unmanipulated, G-CSF–primed bone marrow transplantation for patients with high-risk hematologic malignancies. Blood 2013; 121: 849–857.

    Article  CAS  Google Scholar 

  12. Champlin R, Hesdorffer C, Lowenberg B, Martelli MF, Mertelsmann RH, Reisner Y et al. Haploidentical ‘megadose’ stem cell transplantation in acute leukemia: recommendations for a protocol agreed upon at the Perugia and Chicago meetings. Leukemia 2002; 16: 427–428.

    Article  CAS  Google Scholar 

  13. Wang Y, Liu QF, Xu LP, Liu KY, Zhang XH, Ma X et al. Haploidentical vs identical-sibling transplant for AML in remission: a multicenter, prospective study. Blood 2015; 125: 3956–3962.

    Article  CAS  Google Scholar 

  14. Luznik L, Fuchs EJ . High-dose, post-transplantation cyclophosphamide to promote graft-host tolerance after allogeneic hematopoietic stem cell transplantation. Immunol Res 2010; 47: 65–77.

    Article  CAS  Google Scholar 

  15. Szydlo R, Goldman JM, Klein JP, Gale RP, Ash RC, Bach FH et al. Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings. J Clin Oncol 1997; 15: 1767–1777.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology Biology, University Hospital, Nantes, France

    A Desjonqueres, Y Le Bris, M C Béné & M Eveillard

  2. Department of Clinical Hematology, University Hospital, Nantes, France

    A Desjonqueres, P Peterlin, T Guillaume, J Delaunay, P Moreau & P Chevallier

  3. Department of Virology, University Hospital, Nantes, France

    M Illiaquer

  4. Department of Transfusion, Etablissement Français du Sang, Nantes, France

    A Duquesne

  5. Le Confluent, Nantes, France

    J Delaunay

  6. Department of Pediatric Onco-Hematology, University Hospital, Nantes, France

    F Rialland

Authors
  1. A Desjonqueres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Illiaquer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Duquesne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y Le Bris
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P Peterlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Guillaume
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J Delaunay
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F Rialland
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P Moreau
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M C Béné
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P Chevallier
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M Eveillard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Eveillard.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Desjonqueres, A., Illiaquer, M., Duquesne, A. et al. Longer delay of hematological recovery and increased transfusion needs after haploidentical compared to non-haploidentical stem cell transplantation. Bone Marrow Transplant 51, 1150–1152 (2016). https://doi.org/10.1038/bmt.2016.80

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2016.80

This article is cited by

Search

Advanced search

Quick links