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Cotransplantation of haploidentical hematopoietic stem cells and allogeneic bone marrow‐derived mesenchymal stromal cells as a first‐line treatment in very severe aplastic anemia patients with refractory infections
Author(s) -
Yue Chunyan,
Ding Yingying,
Gao Yang,
Li Li,
Pang Yan,
Liu Zenghui,
Zhang Hang,
Xiao Yang,
Jiang Zujun,
Xiao Haowen
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13060
Subject(s) - medicine , busulfan , bone marrow , neutropenia , cyclophosphamide , hematopoietic stem cell transplantation , mesenchymal stem cell , transplantation , bone marrow failure , aplastic anemia , stem cell , refractory (planetary science) , surgery , haematopoiesis , gastroenterology , pathology , chemotherapy , biology , astrobiology , genetics
Objectives In patients with very severe aplastic anemia ( VSAA ), neutropenia is prolonged and persistent, resulting in refractory overwhelming infections. Hematopoiesis recovery is urgently needed. Methods Six patients with de novo VSAA lacking HLA ‐identical sibling donors and those who experienced refractory infections underwent haploidentical related donor ( HRD ) hematopoietic stem cell transplantation ( HSCT ) as a first‐line therapy. The conditioning regimen consisted of busulfan, cyclophosphamide, and rabbit antithymocyte globulin. Culture‐expanded allogeneic bone marrow‐derived mesenchymal stromal cells were infused on day 0 and day +14. Results From diagnosis to HSCT , 6 patients experienced a total of 28 episodes of persistent fever, and the median number was 4 (range, 3‐7). All cases developed major bacterial infections and invasive pulmonary fungal infection pre‐ HSCT . The median time from diagnosis to HSCT was 2 months (range, 1‐3.5 months). All patients achieved sustained, full donor chimerism, and the median time of myeloid recovery and platelet engraftment was 13 days (range, 9‐19 days) and 15.5 days (range, 10‐23 days), respectively. One patient died of aGVHD , and 5 patients are alive after a median follow‐up of 21 months (range 17‐40.5). Conclusions Upfront HRD ‐ HSCT may be a safe and promising choice for patients with VSAA in critical situations without suitably matched donors.