High dose, post- transplantation Cy promotes tolerance in alloreactive host and donor T cells and is effective as prophylaxis of GVHD. The safety and effi cacy of posttransplantation Cy after nonmyeloablative conditioning was demonstrated by more series of recipients from haploidentical related donor with poor hematological disease. We report our experience on 12 patients with advanced HD who underwent related haploidentical T replete bone marrow transplantation from two institutions. At transplantation, median age was 35 years (range 23 -61). All patients received non myeloablative conditioning with Cy/Fludarabine/TBI 200 rads. GVHD prophylaxis consisted of Cy (50 mg/kg intravenously) on days + 3 and + 5 and MMF + Cyclosporine (n.7) or tacrolimus (n.5). Most patients (8/12) had refractory or active disease at BMT and all had failed autologous BMT. Sustained engraftment of donor cells occurred in all 12 patients with bone marrow chimerism 100% donor. The median time to neutrophils recovery (>500/ mcl) and platelets recovery (>20.000/mcl) was respectively +19 and +25 days from BMT. No graft failure was observed. High dose of posttrasplantation Cy was well tolerated without toxicities. The incidence of grade II-IV GVHD was 8% (1 patient with cutaneous GVHD). The chronic GVHD was absent. The absolute lymphocyte count on day +30 and +60 was respectively 100/mcl and 600/mcl. The opportunistic infections complications are: 1 pulmonary Aspergillosis,2 sepsis (E. Coli), 2 pneumonia, 1 EBV reactivation a 5 CMV infections (1 disease). With a median follow up of 9 months (range 2 - 20) all patients are alive. No patients died for TRM. Relapse incidence was 33% (4 pts), after a median time of 10 months fom BMT. In conclusion our experience confi rms that high dose post transplant CY is effective as prophylaxis of GVHD after haploidentical BMT, can prevent rejection and does not appear to eliminate the allogeneic graft versus lymphoma effect.
Full conference title:
Annual Meeting of the EBMT, 37th
- EBMT 37th (2011)