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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (3) : 306-315     DOI: 10.1007/s11684-013-0279-x
REVIEW |
Advancement of human leukocyte antigen-partially matched related hematopoietic stem cell transplantation
Xiaodong Mo, Xiaojun Huang()
Peking University People’s Hospital & Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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Abstract  

Allogeneic hematopoietic stem cell transplantation (HSCT) is one of the most effective options for hematological malignancies, and human leukocyte antigen-partially matched related donors (PMRDs) are a valuable option for HSCT. Several protocols (with or without ex vivo T-cell depletion (TCD)) have been established worldwide. TCD including CD34+ positive selection and CD3/CD19 depletion has successfully overcome the human leukocyte antigen disparity. However, TCD is associated with prolonged immune deficiencies, increased risks of infectious complications, and high transplantation-related mortality. PMRD HSCT without ex vivo TCD is well developed, and numerous patients have benefitted from it. Here, we review the literature on PMRD HSCT.

Keywords partially matched related donor      hematopoietic stem cell transplantation      allogeneic     
Corresponding Authors: Huang Xiaojun,Email:huangxiaojun@bjmu.edu.cn   
Issue Date: 05 September 2013
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0279-x     OR     http://academic.hep.com.cn/fmd/EN/Y2013/V7/I3/306
Perugia protocolTuebingen protocol
Number of patients10461
Age, median(range) (year)33 (9-64)46 (19-65)
Disease status, high-risk, number (%)104 (100)61 (100)
Transplantation procedureCD34 + cell positive selected G-PB graftsCD3/CD19 depleted G-PB grafts
Transplant outcomes
Acute GVHD, grade II–IV8%46%
Chronic GVHD7%18%
Relapse16% in patients HSCT in CR, and 51% in those HSCT in relapse31% at 2 years
Transplant-related mortality36.5%42% at 2 years
Leukemia-related mortality48% and 46% for AML and ALL, respectively25% at 2 years
Overall survivalNA28% at 2 year
Tab.1  Comparison of main protocols designed by different groups in PMRD HSCT with TCD []
Cell populationCD34 selectionCD3/CD19 depletion
Total cell number, pre5.8 × 10105.0 × 1010
Total cell number, post0.03 × 10101.5 × 1010
T cells0.11%0.003%
T-cell depletion4.6 log4.4 log
CD19+ cellsNot done0.003%
Stem cell purity97.5%0.97%
Stem cell recovery78%59%
NK cells/kg0.003 × 10635 × 106
Monocytes/kg0.3 × 106130 × 106
Granulocytes/kg0.3 × 10638 × 106
Tab.2  Graft composition between CD34 selection and CD3/CD19 depletion []
ChinaAmericaKorea
PekingUniversity [5]DukeUniversity [56]MinnesotaUniversity Minnesota[55]Pusan NationalUniversity [59]
Number of patients820495083
Age, median(range) (year)25 (3-57)48 (17-66)48 (7-70)40 (16-70)
Disease status, high risk, number (.%)195 (25.8)30 (61)4 (8)35 (42)
Conditioning regimenAra-C/BU/CY/Me-CCNU/ATGCY/FLU/ alemtuzumabCY/FLU/TBIBU/FLU/ATG
Transplant outcomes
Acute GVHD, grade II–IV42.9% at day 10016%40% at day 10020%
Chronic GVHD52.9% at 2 years14%13% at 1 year34%
Relapse18.0% at 2 yearsNA45% at 1 yearAL: CR1:27%;CR2/CR3: 32%;Refrectroy: 79%; MDS: 20%
Transplant-related mortality18.1% at 3 years31%7% at 1 year18%
Leukemia-related mortality67.3% at 3 years43% at 1 year48% at 1 yearAL:CR1:60%;CR2/CR3:53%; Refrectory:9%; MDS:53%
Overall survival63.2% at 3 years31% at 1 year62% at 1 yearAL:CR1:60%;CR2/CR3:41%; Refrectory:9%; MDS:53%
Tab.3  Comparison of main protocols designed by different group in PMRD HSCT without TCD
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