Hodkin,Chemo,KMT

**Prof. Wust** · 13.02.2003, 18:56

RE: Hodkin,Chemo,KMT

Da möchte ich Sie bitten, mit den Spezialisten von einer KMT-Station zu sprechen. Natürlich wird man weitgehende Kompatibilität anstreben. Aber welche Risiken bei solchen Inkongruenzen bestehen und welche Maßnahmen man da ergreifen kann, wissen die Experten am besten. In der Literatur werden erfolgreiche KMT mit haploidentischen Stammzellen beschrieben, wie unten als Beispiel angefügt. Offenbar ist aber ein Nachteil gegenüber passenden Spendern (matched).

A clinical study of haploidentical transplantation using granulocyte colony-stimulating factor stimulating donor bone marrow]
AU: Chen,-H; Ji,-S; Wang,-H
AD: Department of Hematology, General Hospital of Air Force PLA, Beijing 100036, China.
SO: Zhonghua-Nei-Ke-Za-Zhi. 2001 Nov; 40(11): 760-3
AB: OBJECTIVE: To explore the effects of reducing the incidence of severe acute graft-versus-host disease (GVHD) and improving the disease free survival(DFS) in haploidentical donor transplantation by granlocyte colony-stimulating factor (G-CSF) administration to donor before harvesting and a number of immunosuppresants added to host. METHODS: Thirteen patients with leukemia received allo-bone marrow transplantation (BMT) from two or three HLA loci mismatched related donor (haploidentical group). The clinical outcomes of the bone marrow transplantion were compared with thase of 13 consecutive HLA identical sibling transplantion (identical group). In haploidentical donor BMT, the donors of patients were given G-CSF (Lenograstim Chugai) 250 micrograms/day for seven doses prior to marrow harvest. CSA, MTX, ATG and mycophenolate mofetil (MMF) were combined for GVHD prophylaxis. ATG 5 mg/kg/day was infused for 4 days before transplantation and MMF was adminisered from 7th day after. RESULTS: All the patients were engrafted. The median number of CD34+ cells in graft was 6.1 x 10(6)/kg in haploidentical group and 2.5 x 10(6)/kg in identical group (P < 0.01). The median number of CD3+ cells was 50.5 x 10(6)/kg and 47.0 x 10(6)/kg respectively (P > 0.05). All patients had 100% donors hematopoietic cells after transplantation by cytogenetic evidence analysis. Five of the thirteen patients (38.5%) in haploidentical group and three of the thirteen patients(23.1%) in identical group experienced II-IV acute GVHD (P > 0.05). The probability of chronic GVHD was 87.5% in haploidentical group and 67.5% in identical group (P > 0.05), However none in both groups developed extensive cGVHD. The median follow-up duration was 453 days (range 180-690 days) for haploidentical group and 510 days (range 220-810 days) for identical group. In haploidentical group, five patients died from transplant related mortality (3 GVHD, 2 infection), none relapsed and eight patients(61.5%) survive in disease free situation. In identical group, two patients died from transplant related mortality (1 GVHD, 1 infection), two patients died from relapse and nine patients (69.2%) survive in disease free situation. DFS in haploidentical group and in identical group was similar(P > 0.05). CONCLUSION: The transplants from haploidentical donor used in this study is 3 effective and feasible in preventing acute severe GVHD and improving DFS.

Superior survival associated with transplantation of matched unrelated versus one-antigen-mismatched unrelated or highly human leukocyte antigen-disparate haploidentical family donor marrow grafts for the treatment of hematologic malignancies: establishing a treatment algorithm for recipients of alternative donor grafts.
AU: Drobyski,-William-R; Klein,-John; Flomenberg,-Neal; Pietryga,-Daniel; Vesole,-David-H; Margolis,-David-A; Keever-Taylor,-Carolyn-A
AD: Bone Marrow Transplant Program, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA. [email protected]
SO: Blood. 2002 Feb 1; 99(3): 806-14
AB: The purpose of this study was to compare transplantation outcomes in patients with hematologic malignancies who received marrow grafts from either phenotypically matched unrelated, one-antigen-mismatched unrelated, or highly human leukocyte antigen (HLA)-disparate family donors. Between 1993 and 2000, 139 patients underwent transplantation from unrelated donors (81 matched and 58 mismatched) and 48 patients received marrow grafts from family donors that were mismatched at 2, 3, or 4 of 8 HLA loci. All patients received a standardized conditioning regimen and a graft-versus-host disease (GVHD) prophylaxis schedule with the exception of recipients of haploidentical marrow grafts, who received antithymocyte globulin after bone marrow transplantation as additional immunosuppression. There was no statistically significant difference in the rate of engraftment, or the cumulative incidences of acute and chronic GVHD between any of the 3 groups. The 2-year cumulative incidence of relapse was lower in matched unrelated patients (25%, P =.01) and mismatched unrelated patients (26%, P =.014) than in haploidentical patients (42%). Transplant-related mortality was significantly higher in recipients of mismatched unrelated grafts (45%, P =.01) and haploidentical grafts (42%, P =.001) compared with recipients of matched unrelated marrow grafts (23%). This resulted in a significantly higher probability of overall survival for matched unrelated patients (58%) versus either mismatched unrelated (34%, P =.01) or haploidentical (21%, P =.002) patients. There was no statistically significant difference in survival between patients who received mismatched unrelated grafts versus those who received haploidentical grafts. This study supports a donor selection algorithm whereby patients who lack a closely matched family donor be offered a phenotypically matched unrelated donor if available. There is no apparent advantage to using a mismatched unrelated versus a highly HLA-disparate family donor.

**1Lore** · 15.02.2003, 13:45

RE: Hodkin,Chemo,KMT

Ich habe auch eine Adresse gefunden, wo Informationen stehen:

http://www.evi-smeh-fonds.at/grund1.htm

Ich würde mich an ihrer Stelle mit anderen Patienten die eine haploidentischer KM hinter sich haben in Verbindung setzen, ev. auch durch spezielle Foren für MH z.B.
http://home.t-online.de/home/morbus-...n/homepage.htm

oder: http://www.krebs-kompass.de/Forum/sh...hp3?id=18&UIN=

Mein Sohn (19) hatte MH und autologe SZT, da habe ich mich auch mit anderen Betroffenen ausgetauscht und das war für uns sehr hilfreich.
Das war vor einem Jahr und heute geht es ihm ganz gut - auch alles Gute, liebe Grüße
lore

Hodkin,Chemo,KMT

Hodkin,Chemo,KMT

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