[A clinical study of haploidentical transplantation using granulocyte colony-stimulating factor stimulating donor...

To explore the effects of reducing the incidence of severe acute graft-versus-host disease (GVHD) and improving the disease free survival(DFS) in haploidentical donor transplantation by granlocyte colony-stimulating factor (G-CSF) administration to donor before harvesting and a number of immunosuppresants added to host.

Thirteen patients with leukemia received allo-bone marrow transplantation (BMT) from two or three HLA loci mismatched related donor (haploidentical group). The clinical outcomes of the bone marrow transplantion were compared with thase of 13 consecutive HLA identical sibling transplantion (identical group). In haploidentical donor BMT, the donors of patients were given G-CSF (Lenograstim Chugai) 250 micrograms/day for seven doses prior to marrow harvest. CSA, MTX, ATG and mycophenolate mofetil (MMF) were combined for GVHD prophylaxis. ATG 5 mg/kg/day was infused for 4 days before transplantation and MMF was adminisered from 7th day after.

All the patients were engrafted. The median number of CD34+ cells in graft was 6.1 x 10(6)/kg in haploidentical group and 2.5 x 10(6)/kg in identical group (P < 0.01). The median number of CD3+ cells was 50.5 x 10(6)/kg and 47.0 x 10(6)/kg respectively (P > 0.05). All patients had 100% donors hematopoietic cells after transplantation by cytogenetic evidence analysis. Five of the thirteen patients (38.5%) in haploidentical group and three of the thirteen patients(23.1%) in identical group experienced II-IV acute GVHD (P > 0.05). The probability of chronic GVHD was 87.5% in haploidentical group and 67.5% in identical group (P > 0.05), However none in both groups developed extensive cGVHD. The median follow-up duration was 453 days (range 180-690 days) for haploidentical group and 510 days (range 220-810 days) for identical group. In haploidentical group, five patients died from transplant related mortality (3 GVHD, 2 infection), none relapsed and eight patients(61.5%) survive in disease free situation. In identical group, two patients died from transplant related mortality (1 GVHD, 1 infection), two patients died from relapse and nine patients (69.2%) survive in disease free situation. DFS in haploidentical group and in identical group was similar(P > 0.05).

The transplants from haploidentical donor used in this study is 3 effective and feasible in preventing acute severe GVHD and improving DFS.