A Pilot Study of Microtransplantaion of Peripheral Blood Stem Cells for Patients with Advanced Hematologic Malignancies

Abstract

Microtransplantation is a procedure of mismatched peripheral blood stem cell infusion without immunosuppressive therapy in patients who have not HLA matched related donor of sibling. It is one of cellular immunotherapy proposed to be effective in management of advanced hematological malignancies. The efficacy of microtransplantation is believed to be related to GVL effect of allogenic PBSC transplantation. Advanced hematological malignancies is thought to be resistant to all conventional therapy and need new line of treatment to be safe and effective than the toxicity of salvage therapy with minimal or no effect. In our study we assess the safety and efficacy of microtansplantion as new immunotherapy to resistant or refractory hematological malignancies. The study included 11 recipients of G-CSF-mobilized HLA mismatched related donor peripheral blood stem cell without GVHD prophylaxis for different types of refractory hematologic malignancies from 12/2012 to 3/2016. All enrolled patients were collected from Bone Marrow Transplantation Unit in Ain Shams University Hospital and Oncology and Hematology Hospital (non-military patients) in Maadi Armed Forces Medical Compound after informed consent approved by ethical committee of Ain Shams University Faculty of medicine.

Inclusion criteria 1) Patients have refractory or resistant hematological malignancies with partial response or resistance after at least 2 lines of conventional therapy. 2) Age 10 -65 years old. 3) No fully HLA matched related donor.

Exclusion criteria 1) Pregnant patients. 2) Patients with HIV infection. 3) Patients with active Infections or active comorbidity diseases. 4. Pre-transplantation assessment: All the patients in this study were subjected to: a) Full medical history and thorough clinical examination.

b) Routine pre-transplant assessment including:

 Complete blood picture, blood group and Rh.  Liver profile which includes: liver enzymes, serum albumin, total proteins, total and direct bilirubin and LDH level.  Renal profile which includes: blood urea nitrogen, serum creatinine, serum uric acid, serum Na, serum K, serum ca, serum Mg and corrected creatinine clearance.  Random blood sugar.  Lipid profile which includes: Total cholesterol level, triglycerides, LDL and HDL cholesterol.  Coagulation profile which includes: PT, PTT, INR.  Viral markers which include : HCVAb, HBsAg,