SymbolNon-myeloablative allogeneic hematopoietic stem cells transplantation for the treatment of elderly patients with acute leukemia

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Abstract

BACKGROUND:

Non-myeloablative allogeneic hematopoietic stem cells transplantation can reduce the intensity of conditioning regimen, and decrease the transplantation related mortality rate.

OBJECTIVE:

To analyze the efficacy and safety of non-myeloablative allogeneic hematopoietic stem cells transplantation for the treatment of elderly patients with acute leukemia.

METHODS:

A 71-year-old female patient with acute mononuclear cell leukemia M5b underwent the non-myeloablative allogeneic hematopoietic stem cells transplantation. The donor was the younger brother of the patient who was 60 years old, ABO blood type was the same and the HLA loci were mismatched. The conditioning regimen contained fludarabine, thiotepa, cyclophosphamide and Myleran, human anti-thymocyte globulin(ATG), basiliximab, cyclosporine, mycophenolate mofetil and gamma globulin were used for graft-versus-host disease (GVHD) prophylaxis. The prophylaxis and support therapy of complication after transplantation consisted of Ganciclovir for cytomegalovirus infection, prostaglandin E1, salvia Miltiorrhiza; Heparin and ursodeoxycholic acid for veno-occlusive disease; Granulocyte colony-stimulating factor (G-CSF) 5 μg/kg per day was used when the absolute neutrophil count decreased to 0.5×109IL. Red cells and platelet were infused if necessary. Peripheral blood stem cells (PBSC) of the donor were mobilized with G-CSF for 7 successive days. PBSC were collected and infused to the patient at the 6th and 7th days.

RESULTS AND CONCLUSION:

Hemopoiesis and immunology reconstruction was completed at the 28th day after transplantation. Results of short tandem repeat (STR) detection shows that the DNA from the donor was the same as the patient at the 50th day after transplantation. The patient suffered from hemorrhagic cystitis and sepsis (Burkholderiacepacia) after transplantation for 20–30 days. Two months later, the patient presented with jaundice and hepatic impairment and she was diagnosed as having acute GVHD (liver, grade 3). These were controlled with antibiotics and adjusting the regime of immunosuppressive drugs. These findings indicate that non-myeloablative allogeneic hematopoietic stem cells transplantation based on a pretreatment regime containing fludarabine is safe and effective for elderly acute leukemia patients with a variety of complications.

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