Outcomes of allogeneic hematopoietic stem cell transplantation for 18 patients with paroxysmal nocturnal haemoglobinuria.
- Author:
Feng CHEN
1
;
Depei WU
1
;
Xiaowen TANG
1
;
Miao MIAO
1
;
Chengcheng FU
1
;
Huiying QIU
1
;
Zhengming JIN
1
;
Shengli XUE
1
;
Xiao MA
1
;
Aining SUN
1
;
Weirong CHANG
1
;
Changgeng RUAN
1
Author Information
- Publication Type:Journal Article
- MeSH: Anemia, Aplastic; therapy; Antilymphocyte Serum; Busulfan; Cyclophosphamide; Cyclosporine; Disease-Free Survival; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Hemoglobinuria, Paroxysmal; therapy; Humans; Methotrexate; Mycophenolic Acid; analogs & derivatives; Retrospective Studies; Siblings; Tacrolimus; Transplantation Conditioning; Treatment Outcome; Unrelated Donors; Vidarabine; analogs & derivatives
- From: Chinese Journal of Hematology 2015;36(12):1005-1010
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo evaluate the outcomes of allogeneic hematopoietic stem cell transplantation(allo-HSCT)for paroxysmal nocturnal haemoglobinuria(PNH)and aplastic anemia(AA)- PNH syndrome.
METHODSThe clinical data of 18 PNH or AA-PNH patients, including 4 classic PNH and 14 AA-PNH, received allo-HSCT from Dec 2007 to Feb 2015 were analyzed retrospectively. Nine patients received HLA-haploidentical donor HSCT(1 patient received salvage HLA-haploidentical donor HSCT after the graft failure of double cord blood transplantation), 7 patients received HLA-identical sibling donor HSCT, and 2 HLA-identical unrelated donor HSCT. The conditioning regimens were as follow: 13 patients received modified BU/CY- based regimens, 5 non- myeloablative regimens [fludarabine (Flu) + antithymocyte globulin(ATG)+ cyclophosphamide(CY)or busulfan(BU)]. Prophylaxis for graft- versushost disease(GVHD): the patients with HLA-identical sibling donor received cyclosporine(CsA)plus short-term methotrexate(MTX), the patients with HLA -haploidentical donor or HLA-identical unrelated donor received CsA or tacrolimus(FK506)+ mycophenolate mofetil(MMF)+ short- term methotrexate (MTX).
RESULTSAll patients were engrafted successfully(1 patient engrafted by haploidentical donor after the graft failure of double cord blood transplantation). The median days of neutrophils(ANC)above 0.5 × 109/L and platelets (PLT) more than 20 × 10⁹/L were 11(10- 26)days and 15(11- 120)days, respectively. Three patients(17.6%)developed acute GVHD(aGVHD), 2 for grade Ⅱ aGVHD, 1 for grade Ⅳ aGVHD. Of 16 patients, 2 occurred limited chronic GVHD(cGVHD). After a median follow-up of 14.6(2.0-86.7)months, 3 patients(17.6%)died, out of which one died of severe aGVHD, one died of severe pulmonary infection, one pulmonary infection with transplant- associated thrombotic microangiopathy. The 5- year estimated disease free survival was(80.5 ± 10.2)%. No patient relapsed.
CONCLUSIONAllo-HSCT is an effective and curable therapy for PNH or AA-PNH with improved prognosis, and offers a valid therapeutic option for these patients before humanized monoclonal antibody against C5 are widely used clinically.