T cell replete–haploidentical second hematopoietic stem cell transplantation for primary graft failure in pediatric patients with hematologic malignancies
Kazuhiro Mochizuki
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorHideki Sano
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorMitsuko Akaihata
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorShogo Kobayashi
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorTomoko Waragai
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorYoshihiro Ohara
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorNobuhisa Takahashi
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorMasaki Ito
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorKazuhiko Ikeda
Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
Search for more papers by this authorHitoshi Ohto
Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
Search for more papers by this authorCorresponding Author
Atsushi Kikuta
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Correspondence
Atsushi Kikuta, Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan.
Email: [email protected]
Search for more papers by this authorKazuhiro Mochizuki
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorHideki Sano
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorMitsuko Akaihata
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorShogo Kobayashi
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorTomoko Waragai
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorYoshihiro Ohara
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorNobuhisa Takahashi
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorMasaki Ito
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Search for more papers by this authorKazuhiko Ikeda
Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
Search for more papers by this authorHitoshi Ohto
Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
Search for more papers by this authorCorresponding Author
Atsushi Kikuta
Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
Correspondence
Atsushi Kikuta, Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan.
Email: [email protected]
Search for more papers by this authorAbstract
GF is one of the fatal complications of allogeneic HSCT. To rescue patients with primary GF, a second HSCT should be conducted as soon as possible, but the optimal donor source and technique have yet to be established. In this study, we retrospectively analyzed six children with hematologic malignancies who received TCR-haploidentical second HSCT for primary GF. The median interval between the prior HSCT and the second HSCT was 37.5 days. All patients received fludarabine and ATG containing reduced-intensity re-conditioning before the second HSCT. All patients, except one who died early, achieved both neutrophil and Plt engraftment at a median time of 15 and 33 days, respectively. Chimerism analysis showed that all engrafted patients achieved complete donor chimerism within 3 weeks. Four patients developed acute GVHD, and three patients developed chronic GVHD. TRM occurred in two patients. Median follow-up of the four survivors was 6.8 years, and all remained in sustained remission until the last follow-up. These results suggested that a TCR-haploidentical second HSCT for pediatric patients is feasible, and this approach may provide a potent option for children with primary GF.
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