Outcome of Non-T-Cell-Depleted HLA-Haploidentical Hematopoietic Stem Cell Transplantation from Family Donors in Children and Adolescents

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• 作者：Takao Yoshihara (1)
  Keiko Okada (2)
  Michihiro Kobayashi (3)
  Atsushi Kikuta (4)
  Koji Kato (5)
  Naoto Adachi (6)
  Akira Kikuchi (7)
  Hiroyuki Ishida (1)
  Yasuzou Hirota (8)
  Hiroshi Kuroda (9)
  Yoshihisa Nagatoshi (10)
  Takeshi Inukai (11)
  Kazutoshi Koike (12)
  Hisato Kigasawa (13)
  Hiroshi Yagasaki (14)
  Kiriko Tokuda (15)
  Tomoko Kishimoto (16)
  Takahide Nakano (17)
  Naoto Fujita (18)
  Hiroaki Goto (19)
  Yozo Nakazawa (20)
  Hirokazu Kanegane (21)
  Akinobu Matsuzaki (22)
  Yuko Osugi (23)
  Daiichiro Hasegawa (24)
  Nobuhiko Uoshima (25)
  Kazuhiro Nakamura (26)
  Masahiro Tsuchida (12)
  Ryuhei Tanaka (27)
  Arata Watanabe (28)
  Hiromasa Yabe (29)
  
• 关键词：Hematopoietic stem cell transplantation ; HLA ; haploidentical donor ; Noninherited maternal antigen (NIMA) ; Long ; term fetomaternal microchimerism ; Childhood
• 刊名：International Journal of Hematology
• 出版年：2007
• 出版时间：April 2007
• 年：2007
• 卷：85
• 期：3
• 页码：246-255
• 全文大小：146KB
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• 作者单位：Takao Yoshihara (1)
  Keiko Okada (2)
  Michihiro Kobayashi (3)
  Atsushi Kikuta (4)
  Koji Kato (5)
  Naoto Adachi (6)
  Akira Kikuchi (7)
  Hiroyuki Ishida (1)
  Yasuzou Hirota (8)
  Hiroshi Kuroda (9)
  Yoshihisa Nagatoshi (10)
  Takeshi Inukai (11)
  Kazutoshi Koike (12)
  Hisato Kigasawa (13)
  Hiroshi Yagasaki (14)
  Kiriko Tokuda (15)
  Tomoko Kishimoto (16)
  Takahide Nakano (17)
  Naoto Fujita (18)
  Hiroaki Goto (19)
  Yozo Nakazawa (20)
  Hirokazu Kanegane (21)
  Akinobu Matsuzaki (22)
  Yuko Osugi (23)
  Daiichiro Hasegawa (24)
  Nobuhiko Uoshima (25)
  Kazuhiro Nakamura (26)
  Masahiro Tsuchida (12)
  Ryuhei Tanaka (27)
  Arata Watanabe (28)
  Hiromasa Yabe (29)
  
  1. Department of Pediatrics, Matsushita Memorial Hospital, 5-55, Sotojima-cho, Moriguchi-shi, 570-8540, Moriguchi, Japan
  2. Osaka University Graduate School of Medicine, Osaka, Japan
  3. Graduate School of Medicine, Kyoto University, Kyoto, Japan
  4. Fukushima Medical University, Fukushima, Japan
  5. Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
  6. Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
  7. Saitama Children鈥檚 Medical Center, Saitama, Japan
  8. Show a University Fujigaoka Hospital, Yokohama, Japan
  9. Kyoto City Hospital, Kyoto, Japan
  10. National Kyushu Cancer Center, Fukuoka, Japan
  11. Faculty of Medicine, University of Yamanashi, Nakakoma, Japan
  12. Ibaraki Children鈥檚 Hospital, Mito, Japan
  13. Kanagawa Children鈥檚 Medical Center, Yokohama, Japan
  14. Graduate School of Medicine, Nagoya University, Nagoya, Japan
  15. Ehime University School of Medicine, Touon, Japan
  16. Nara Medical University, Kashihara, Japan
  17. Kansai Medical University, Moriguchi, Japan
  18. Hiroshima Red-Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
  19. Yokohama City University School of Medicine, Yokohama, Japan
  20. Shinshu University School of Medicine, Matsumoto, Japan
  21. Faculty of Medicine, University of Toyama, Toyama, Japan
  22. Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  23. Osaka City General Hospital, Osaka, Japan
  24. Hyogo Prefectural Kobe Children鈥檚 Hospital, Kobe, Japan
  25. Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Japan
  26. Hiroshima University School of Medicine, Hiroshima, Japan
  27. Saitama Medical School Hospital, Iruma, Japan
  28. Nakadori General Hospital, Akita, Japan
  29. Tokai University School of Medicine, Isehara, Japan
  

文摘

Non-T-cell-depleted HLA-haploidentical hematopoietic stem cell transplantation (SCT) from family members has been reported, but its effectiveness and safety are not fully known. In this study, we examined the outcomes of 83 children and adolescents with nonmalignant (n = 11) or malignant (n = 72) disorders who underwent SCT mismatched at 2 or 3 HLA loci, either from the mother (n = 56), a noninherited maternal antigen (NIMA)-mismatched sibling (n = 14), or the father/a noninherited paternal antigen (NIPA)-mismatched sibling (n = 13). Engraftment was satisfactory. Severe (grade III-IV) acute graft-versus-host disease (GVHD) was noted only in malignant disease, with an incidence of 21 of 64 evaluable patients. GVHD prophylaxis with a combination of tacrolimus and methotrexate was significantly associated with a lower risk of severe acute GVHD, compared with other types of prophylaxis(P = .04). Nine of 11 patients with nonmalignant disease and 29 of 72 patients with malignant disease were alive at a median follow-up of 26 months (range, 4-57 months). Outcomes were not significantly different among the 3 donor groups (mother versus NIMA-mismatched sibling versus father/NIPA-mismatched sibling) for the malignancy disorders. Our results indicate that non-T-cell-depleted HLA-haploidentical SCT may be feasible, with appropriate GVHD prophylaxis, for young recipients who lack immediate access to a conventional stem cell source.