Myeloablative conditioning regimens with combined of haploidentical and cord blood transplantation for myelodysplastic syndrome patients

Abstract

The purpose of this study was to evaluate the strategy of haploidentical (HID) stem cell combined with a small doses of umbilical cord blood (UCB) from a third-party donor transplantation (haplo-cord transplant) for treatment of myelodysplastic syndromes (MDS), by comparing with identical-sibling donor (ISD) transplantation. Eighty-five patients were included between January 2012 and December 2015, with a median 40 years old. Forty-eight patients received haplo-cord transplant and 37 patients received ISD transplant. Haplograft engraftment succeeded in all haplo-cord patients. For haplo-cord and ISD transplantation, adjusted cumulative incidences of grades 2-4 acute GvHD at 100 days were 27 and 11% (P=0.059); adjusted cumulative incidences of chronic GvHD at 2 years were 22 and 34% (P=0.215). The 2-year adjusted probabilities of overall survival were 64 and 70% (P=0.518), and of relapse-free survival were 56 and 66% (P=0.306). The 2-year adjusted cumulative incidences of relapse were 12 and 14% (P=0.743), and of non-relapse mortality were 33 and 23% (P=0.291). In conclusion, haplo-cord-HSCT achieves outcomes similar to those of ISD-HSCT for MDS and the haplo-cord-HSCT may potentially improve the outcome of HID- and UCB-HSCT alone. Thus, the haplo-cord transplantation may be a better valid alternative for MDS when an ISD is not available.

Cord Haploidentical Non-In Vitro T Cell Depletion Allogeneic Hematopoietic Stem Cell Transplantation Reduces Relapse of Refractory Acute Leukemia

“…However, previous studies also have shown a significantly lower incidence of GVHD with dUCBT than with single UCBT [39], and also with haplo-cord HSCT than with haplo-HSCT and post-transplantation cyclophosphamide [16]. Moreover, another study using a similar protocol treating myelodysplasia syndrome found a lower incidence of GVHD than seen with HSCT from identical sibling donors (particularly the acute form) [40]. Similar to the foregoing conclusions, we believe that a disturbance in the balance between the protective role of regulatory T cells in UCB and the detrimental effect of the GVG response might be responsible for our observations.…”

Improved outcomes using unmanipulated haploidentical hematopoietic stem cells combined with third‐party umbilical cord blood transplantation for non‐malignant diseases in children: The experience of a single center

“…24 Recently, some studies show that HID transplantation combined with tp-UCB could result in rapid engraftment, low incidences of GVHD, and disease relapse of hematological malignancy. [14][15][16][17] Considering that UCB contains CD4 + CD25 + Tregs and mesenchymal stem cells etc. 25,26 These cells have an immune regulation mechanism that can regulates the hematopoietic microenvironment and therefore play an important role in the prevention of GVHD.…”

“…In total, 109 consecutive children with NMD underwent unmanipulated haploid HSCs combined with tp-UCB transplantation between January 2014 and December 2018. [14][15][16][17] The number of diseases were recorded, including BMFs (n = 62), PID (n = 33), IEM (n = 13), and malignant infantile osteopetrosis (n = 1). BMFs included SAA (n = 60), Diamond-Blackfan anemia (n = 1), and congenital dyserythropoietic anemia (n = 1).…”

“…12,13 Many researches have adopted haploid HSCs combined tp-UCB transplantation to treat leukemia; this can promote engraftment and reduce GVHD, thus achieving good results. [14][15][16][17] However, no previous study has investigated haploid HSCs combined with tp-UCB transplantation for the treatment of pediatric patients with NMD. We conducted a retrospective study of 109 pediatric patients with NMD and investigated the effect of unmanipulated haploid HSCs combined with tp-UCB transplantation.…”

Low-dose anti-thymocyte globulin plus low-dose posttransplant cyclophosphamide as graft-versus-host disease prophylaxis in haploidentical peripheral blood stem cell transplantation combined with unrelated cord blood for patients with hematologic malignancies: a prospective, phase II study

“…Tsai et al [31] reported that haplo/cord reduced-intensity transplantation followed by durable cord blood engraftment achieved similar outcomes compared with HLA-matched unrelated donor (MUD) in older AML and MDS patients. A group from China [32, 33] evaluated another combination strategy of un-manipulated haploidentical stem cells combined with a small dose of umbilical cord blood from a third-party donor (haplo-cord transplant) for hematological malignancies, which was followed by durable haploidentical stem cell engraftment. The results showed that haplo-cord transplant may potentially improve the outcome of HID- and UCB-HSCT alone.…”