Successful outcomes of second hematopoietic stem cell transplantation with total nodal irradiation and ATG conditioning for graft failure in adult patients with severe aplastic anemia

被引:9
作者
Yahng, Seung-Ah [1 ]
Park, Sung-Soo [2 ]
Jeon, Young-Woo [2 ]
Yoon, Jae-Ho [2 ]
Shin, Seung-Hwan [3 ]
Lee, Sung-Eun [2 ]
Cho, Byung-Sik [2 ]
Eom, Ki-Seong [2 ]
Kim, Yoo-Jin [2 ]
Lee, Seok [2 ]
Min, Chang-Ki [2 ]
Kim, Hee-Je [2 ]
Cho, Seok-Goo [2 ]
Kim, Dong-Wook [2 ]
Min, Woo-Sung [2 ]
Lee, Jong Wook [2 ]
机构
[1] Catholic Univ Korea, Dept Hematol, Incheon St Marys Hosp, Coll Med, Incheon, South Korea
[2] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Hematol,Catholic Blood & Marrow Transplantat, Seoul, South Korea
[3] Catholic Univ Korea, Yeoido St Marys Hosp, Coll Med, Dept Hematol, Seoul, South Korea
关键词
BONE-MARROW-TRANSPLANTATION; TOTAL LYMPHOID IRRADIATION; TOTAL-BODY IRRADIATION; VERSUS-HOST-DISEASE; UNRELATED DONORS; RISK-FACTORS; CYCLOPHOSPHAMIDE; REJECTION; ENGRAFTMENT; GVHD;
D O I
10.1038/s41409-018-0154-0
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Data regarding the optimal approach for second allogeneic hematopoietic stem cell transplantation (HSCT) after graft failure (GF) in acquired severe aplastic anemia (SAA) are still limited and heterogeneous. We examined 24 patients who underwent second HLA-matched sibling donor (MSD) peripheral blood HSCT for GF. The reconditioning regimen (TNI-750/ATG) consisted of a single dose of total nodal irradiation (TNI, 750 cGy) and antithymocyte globulin (ATG; Thymoglobulin (R), 1.25 mg/kg/day for 3 days). All but one patient achieved successful engraftment of neutrophils (median 12 days, range 5-21) and platelets (median 15 days, range 9-316). Two patients with subsequent secondary GF achieved successful engraftment after a third HSCT from the same MSD. After a median follow-up of 57.4 months (range, 11.2-155.2), the 5-year overall survival and failure-free survival were 95.7% (95% confidence interval [CI] 87.7-100%) and 87.5% (95% CI 75.2-100%), respectively. One patient developed grade II acute graft-versus-host disease (GVHD), and the 2-year cumulative incidence of chronic GVHD was 23.5% (95% CI 8.1-43.5%). This study demonstrated successful outcomes following a second MSD HSCT in SAA after GF, and the results suggest TNI-750/ATG is a feasible reconditioning option. Future studies with larger cohorts will validate our results.
引用
收藏
页码:1270 / 1277
页数:8
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