The Long Term Survival of the Patients with Refractory Leukemia Treated by Related HLA Haploidentical Stem Cells Transplantation.

Abstract To assess the Long Term Survival of patients with refractory leukemia treated by HLA haploidentical stem cells transplantation. We analysed the outcomes of 35 patients with refractory leukemia who underwent HLA haploidentical peripheral blood stem cells transplantation from August, 1998 to December, 2005. Thirty five patients with refractory leukemia including 16 cases of acute non-lymphocytes leukemia, 11 cases of acute lymphocytes leukemia, 7 cases of chronic myeloid leukemia and 1 case of IV phase of non-Hodgkin lymphoma underwent HLA haploidentical peripheral blood stem cells transplantation. The median age was 25 years old (3– 52 years old). Fourteen patients received stem cells from parent donors, four from daughter and one from son donor, the others from sibling donors. Three HLA locus mismatched in thirteen cases, Two HLA locus mismatched donors in fifteen cases, One HLA locus mismatched in six cases. The conditioning regime consisted of fludara (25mg/m2 ×5d), busufan (4mg/kg ×4d) and cyclophsphamide(60mg/kg ×2d). Rabbit anti-human lymphocyte globulin (5mg/kg ×5d) was added in some patients in conditioning regime. A mean of 5.0 × 108/kg (2.97×108/kg-8.0×108/kg) mono-nucleated cells was grafted. The mean CD34+ cells number was 5.5 ×106/Kg (3–6.5 ×106/kg). Ten patients received 400ml donor derived bone marrow beside donor peripheral stem cells. Thirty-two patients were successfully grafted and one failed to graft and one died with severe fung infection at day 2, and one died from severe veno-occlusive disease at day 28. The mean time of white cell count more than 1×109/L was 14(11–18) days and platelet count more than 20×109/L was 15 (11–18) days. All patients got complete remission in 32 successful grafted patients. Severe acute graft versus host disease occurred in seven patients, and four died. Eight patients suffered from chronic graft versus host disease. Eight patients relapsed and died. The median relapse time was 10 (3–24) months. Fourteen patients are still disease free survival. The three years disease free survival rate was 40%. We concluded from our observation that HLA haploidentical peripheral blood stem cells transplantation may be an effective therapy for refractory leukemia. Some patients with refractory leukemia treated by HLA haploidentical stem cells transplantation could survive with free diseases; Though graft versus leukemia effect may be strong in HLA haploidentical blood stem cells transplantation, leukemia will probably be relapse when the patient without complete remission at transplant.