Successful treatment of acute leukemia by secondary transplantation after the first haploidentical hematopoietic stem cell transplantation failure
-
摘要:
目的 探讨急性白血病患者首次单倍体造血干细胞移植后植入失败的二次移植治疗策略。 方法 2例急性白血病患者首次单倍体造血干细胞移植的2例供者均伴有地中海贫血，分别采集CD34+细胞2.57×106/kg和1.99×106/kg，首次单倍体造血干细胞移植植入失败。二次移植更换为非地中海贫血供者，分别采集CD34+细胞4.28×106/kg和5.75×106/kg，采用减低剂量氟达拉滨（Flu）+白消安（Bu）+抗胸腺细胞球蛋白（ATG）预处理方案行二次移植。 结果 2例患者二次移植中性粒细胞和血小板植入时间分别为+12 d和+10 d、+10 d和+10 d。截止至末次随访时间（分别为二次移植+1 062 d、+265 d），2例患者原发病均完全缓解，无明显移植并发症。 结论 减低剂量预处理的二次移植能够成功治疗急性白血病单倍体造血干细胞移植植入失败。 Abstract:Objective To evaluate the feasibility of secondary transplantation for patients with acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation. Methods Two acute leukemia patients underwent the first haploidentical hematopoietic stem cell transplantation from two donors with thalassemia, and the number of collected CD34+ cells was 2.57×106/kg and 1.99×106/kg per donor, respectively. The first haploidentical hematopoietic stem cell transplantation failed. Secondary transplantation was performed from two non-thalassemia donors, and the number of collected CD34+ cells was 4.28×106/kg and 5.75×106/kg per donor, respectively. A reduced-intensity conditioning regimen consisting of fludarabine (Flu), busulfan (Bu) and antithymocyte globulin (ATG) was adopted for the secondary transplantation. Results For two recipients, the time of secondary transplantation of neutrophil and platelet was +12 d and +10 d, +10 d and +10 d, respectively. Up to the final follow-up (+1 062 d and +265 d after secondary transplantation), the primary diseases of both two recipients have been completely relieved without evident post-transplantation complications. Conclusions Secondary transplantation with reduced-intensity conditioning regimen may successfully treat acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation. -
图 1 例1患者治疗全过程
注：A图为例1患者诊断、化疗、移植、随访全过程；B图为首次单倍体造血干细胞移植过程；C图为二次移植过程。AML为急性髓系白血病；HA为高三尖杉酯碱+阿糖胞苷；D-IA为地西他滨+伊达比星+阿糖胞苷；HD-AraC为大剂量阿糖胞苷；UCB为脐带血；MSC为间充质干细胞；MRD为微小残留病灶。
Figure 1. Treatment procedure of patient 1
-
[1] YABE H. Allogeneic hematopoietic stem cell transplantation for inherited metabolic disorders[J]. Int J Hematol, 2022, 116(1): 28-40. DOI: 10.1007/s12185-022-03383-z. [2] MYERS K, HEBERT K, ANTIN J, et al. Hematopoietic stem cell transplantation for shwachman-diamond syndrome[J]. Biol Blood Marrow Transplant, 2020, 26(8): 1446-1451. DOI: 10.1016/j.bbmt.2020.04.029. [3] MUCHTAR E, DISPENZIERI A, KUMAR SK, et al. Second stem cell transplantation for relapsed refractory light chain (AL) amyloidosis[J]. Transplant Cell Ther, 2021, 27(7): 589. e1-589. e6. DOI: 10.1016/j.jtct.2021.03.031. [4] HUANG XJ. Overcoming graft failure after haploidentical transplantation: is this a possibility?[J]. Best Pract Res Clin Haematol, 2021, 34(1): 101255. DOI: 10.1016/j.beha.2021.101255. [5] LIU Y, FAN Y, ZHANG W, et al. Efficiency and toxicity of ruxolitinib as the salvage treatment in steroid-refractory acute graft-versus-host disease after haplo-identical stem cell transplantation[J]. Transplant Cell Ther, 2021, 27(4): 332. e1-332. e8. DOI: 10.1016/j.jtct.2021.01.019. [6] ATOUI A, EL LABBAN M, GHAOUI N, et al. Complete remission of seronegative rheumatoid arthritis following haplo-identical stem cell transplantation for peripheral T-cell lymphoma[J]. Bone Marrow Transplant, 2020, 55(5): 979-981. DOI: 10.1038/s41409-019-0635-9. [7] 曹丽芹, 施继敏. 异基因造血干细胞移植植入失败研究进展[J]. 浙江大学学报(医学版), 2018, 47(6): 651-658. DOI: 10.3785/j.issn.1008-9292.2018.12.14.CAO LQ, SHI JM. Graft failure in allogeneic hematopoietic stem cell trans-plantation[J]. J Zhejiang Univ(Med Sci), 2018, 47(6): 651-658. DOI: 10.3785/j.issn.1008-9292.2018.12.14. [8] 尹光丽, 李建勇, 缪扣荣. 造血干细胞移植植入失败的研究进展[J]. 南京医科大学学报(自然科学版), 2020, 40(1): 141-146, 150. DOI: 10.7655/NYDXBNS20200129.YIN GL, LI JY, MIAO KR. Progress on graft failure of allogeneic hematopoietic stem cell transplantation[J]. J Nanjing Med Univ, 2020, 40(1): 141-146, 150. DOI: 10.7655/NYDXBNS20200129. [9] LIU Y, HUANG X, FEI Q, et al. Comparison analysis between haplo identical stem cell transplantation and matched sibling donor stem cell transplantation for high-risk acute myeloid leukemia in first complete remission[J]. Sci China Life Sci, 2019, 62(5): 691-697. DOI: 10.1007/s11427-018-9361-2. [10] RUBIO MT, SAVANI BN, LABOPIN M, et al. Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT[J]. J Hematol Oncol, 2016, 9: 25. DOI: 10.1186/s13045-016-0248-3. [11] PARRA SALINAS I, BERMUDEZ A, LÓPEZ CORRAL L, et al. Treatment of steroid-refractory chronic graft-versus-host disease with imatinib: real-life experience of the Spanish group of hematopoietic transplantation (GETH)[J]. Clin Transplant, 2021, 35(5): e14255. DOI: 10.1111/ctr.14255. [12] ZHA J, KUNSELMAN LK, XIE HM, et al. Inducible Sbds deletion impairs bone marrow niche capacity to engraft donor bone marrow after transplantation[J]. Blood Adv, 2022, 6(1): 108-120. DOI: 10.1182/bloodadvances.2021004640. [13] PRABAHRAN A, KOLDEJ R, CHEE L, et al. Clinical features, pathophysiology, and therapy of poor graft function post-allogeneic stem cell transplantation[J]. Blood Adv, 2022, 6(6): 1947-1959. DOI: 10.1182/bloodadvances.2021004537. [14] PARK JH, LEE JH, LEE JH, et al. Incidence, management, and prognosis of graft failure and autologous reconstitution after allogeneic hematopoietic stem cell transplantation[J]. J Korean Med Sci, 2021, 36(23): e151. DOI: 10.3346/jkms.2021.36.e151. [15] YANG G, WANG X, HUANG S, et al. Generalist in allogeneic hematopoietic stem cell transplantation for MDS or AML: epigenetic therapy[J]. Front Immunol, 2022, 13: 1034438. DOI: 10.3389/fimmu.2022.1034438. [16] LOKE J, BUKA R, CRADDOCK C. Allogeneic stem cell transplantation for acute myeloid leukemia: who, when, and how?[J]. Front Immunol, 2021, 12: 659595. DOI: 10.3389/fimmu.2021.659595. [17] PRABAHRAN A, KOLDEJ R, CHEE L, et al. Non-relapse cytopenias following allogeneic stem cell transplantation, a case based review[J]. Bone Marrow Transplant, 2022, 57(10): 1489-1499. DOI: 10.1038/s41409-022-01761-z. [18] SAHA A, BLAZAR BR. Antibody based conditioning for allogeneic hematopoietic stem cell transplantation[J]. Front Immunol, 2022, 13: 1031334. DOI: 10.3389/fimmu.2022.1031334. [19] MAN Y, LU Z, YAO X, et al. Recent advancements in poor graft function following hematopoietic stem cell transplantation[J]. Front Immunol, 2022, 13: 911174. DOI: 10.3389/fimmu.2022.911174. [20] OLSSON R, REMBERGER M, SCHAFFER M, et al. Graft failure in the modern era of allogeneic hematopoietic SCT[J]. Bone Marrow Transplant, 2013, 48(4): 537-543. DOI: 10.1038/bmt.2012.239. [21] CONSTANTINOU VC, BOUINTA A, KARPONI G, et al. Poor stem cell harvest may not always be related to poor mobilization: lessons gained from a mobilization study in patients with β-thalassemia major[J]. Transfusion, 2017, 57(4): 1031-1039. DOI: 10.1111/trf.13951. [22] SANFORD K, ROSEFF SD, ANDERSON J, et al. Harvesting autologous stem cells from a patient with red blood cell abnormalities of β-thalassemia intermedia[J]. Transfusion, 2014, 54(7): 1881-1886. DOI: 10.1111/trf.12579. [23] 许多荣, 李娟, 陈惠珍, 等. 伴海洋性贫血供者外周血造血干细胞采集效果分析[J]. 中国实用内科杂志, 2010, 30(11): 1007-1009.XU DR, LI J, CHEN HZ, et al. Analysis of the collection effect of peripheral blood stem cells in donors with thalassemia[J]. Chin J Pract Intern Med, 2010, 30(11): 1007-1009. [24] 张月梅, 李学英, 张晓燕, 等. 亲缘供者外周血红细胞参数对造血干细胞采集影响的经验分析[J/CD]. 中华细胞与干细胞杂志(电子版), 2022, 12(2): 74-78. DOI: 10.3877/cma.j.issn.2095-1221.2022.02.002 .ZHANG YM, LI XY, ZHANG XY, et al. Relationship between peripheral blood erythrocyte parameters of related donors and hematopoietic stem cell collection[J/CD]. Chin J Cell Stem Cell (Electr Edit), 2022, 12(2): 74-78. DOI:10.3877/cma.j.issn.2095-1221.2022.02.002 .[25] LADETTO M, BÖTTCHER S, KRÖGER N, et al. Methods and role of minimal residual disease after stem cell transplantation[J]. Bone Marrow Transplant, 2019, 54(5): 681-690. DOI: 10.1038/s41409-018-0307-1. [26] RATTANI N, MATHENY C, ECKRICH MJ, et al. Parvovirus B19-associated graft failure after allogeneic hematopoietic stem cell transplantation[J]. Cancer Rep (Hoboken), 2022, 5(1): e1403. DOI: 10.1002/cnr2.1403. [27] CIUREA SO, CAO K, FERNANDEZ-VINA M, et al. The European Society for Blood and Marrow Transplantation (EBMT) consensus guidelines for the detection and treatment of donor-specific anti-HLA antibodies (DSA) in haploidentical hematopoietic cell transplantation[J]. Bone Marrow Transplant, 2018, 53(5): 521-534. DOI: 10.1038/s41409-017-0062-8. [28] TAKANO K, IZUMI T, KAWAMURA T, et al. Successful treatment of secondary graft failure after allogeneic stem cell transplantation for aplastic anemia with eltrombopag[J]. Rinsho Ketsueki, 2022, 63(3): 177-181. DOI: 10.11406/rinketsu.63.177. [29] GIARDINO S, FARACI M, LANINO E, et al. Successful second unrelated donor hematopoietic stem cell transplant in a patient with dyskeratosis congenital after first graft rejection[J]. Exp Clin Transplant, 2017. DOI: 10.6002/ect.2016.0302. [30] TACHIBANA T, YAMAMOTO E, KAWASAKI R, 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[J]. Intern Med, 2015, 54(21): 2749-2752. DOI: 10.2169/internalmedicine.54.4809. [31] MOCHIZUKI K, SANO H, AKAIHATA M, et al. T cell replete-haploidentical second hematopoietic stem cell transplantation for primary graft failure in pediatric patients with hematologic malignancies[J]. Pediatr Transplant, 2017, 21(7). DOI: 10.1111/petr.13043. [32] NAGLER A, OR R, NAPARSTEK E, et al. Second allogeneic stem cell transplantation using nonmyeloablative conditioning for patients who relapsed or developed secondary malignancies following autologous transplantation[J]. Exp Hematol, 2000, 28(9): 1096-1104. DOI: 10.1016/s0301-472x(00)00511-7. [33] 顾斌, 陈广华, 马骁, 等. 非去T细胞半相合造血干细胞移植术后植入失败的初步分析[J]. 实用医学杂志, 2016, 32(20): 3401-3404. DOI: 10.3969/j.issn.1006-5725.2016.20.033.GU B, CHEN GH, MA X, et al. Preliminary analysis on graft failure after non-T-cell depleted haploidentical hematopoietic stem cell transplantation[J]. J Pract Med, 2016, 32(20): 3401-3404. DOI: 10.3969/j.issn.1006-5725.2016.20.033. [34] 张競文, 孙燕玲, 李旭东. 单倍体造血干细胞移植治疗急性淋巴细胞白血病植入失败的二次移植策略[J]. 器官移植, 2018, 9(6): 441-444. DOI: 10.3969/j.issn.1674-7445.2018.06.008.ZHANG JW, SUN YL, LI XD, et al. Secondary transplantation strategy for graft failure of haploidentical hematopoietic stem cell transplantation for acute lymphocyticleukemia[J]. Organ Transplant, 2018, 9(6): 441-444. DOI: 10.3969/j.issn.1674-7445.2018.06.008. [35] GIAMMARCO S, RAIOLA AM, DI GRAZIA C, et al. Second haploidentical stem cell transplantation for primary graft failure[J]. Bone Marrow Transplant, 2021, 56(6): 1291-1296. DOI: 10.1038/s41409-020-01183-9. [36] 马丽萍, 聂大年, 尹松梅, 等. 二次异体造血干细胞移植成功治疗慢性髓系白血病1例[J]. 中山大学学报(医学科学版), 2005, 26(5): 476-600. DOI: 10.3321/j.issn:1672-3554.2005.05.029.MA LP, NIE DN, YIN SM, et al. One case of chronic myeloid leukemia treated by secondary allogeneic hematopoietic stem cell transplantation[J]. J Sun Yat-sen Univ(Med Sci), 2005, 26(5): 476-600. DOI: 10.3321/j.issn:1672-3554.2005.05.029. -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 316
- HTML全文浏览量: 67
- PDF下载量: 41
- 被引次数: 0
