Mixed lymphohaemopoietic chimerism and graft-versus-lymphoma effects after non-myeloablative therapy and HLA-mismatched bone-marrow transplantation

被引:313
作者
Sykes, M [1 ]
Preffer, F
McAfee, S
Saidman, SL
Weymouth, D
Andrews, DM
Colby, C
Sackstein, R
Sachs, DH
Spitzer, TR
机构
[1] Massachusetts Gen Hosp, Bone Marrow Transplantat Sect, Transplantat Biol Res Ctr, Surg Serv, Boston, MA 02129 USA
[2] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02129 USA
[3] Massachusetts Gen Hosp, Dept Med, Bone Marrow Transplantat Program, Boston, MA 02129 USA
[4] Harvard Univ, Sch Med, Boston, MA 02129 USA
关键词
D O I
10.1016/S0140-6736(98)11135-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. HLA-mismatched donor bone-marrow transplantation after standard myeloablative conditioning therapy for haematological malignant disorders has been limited by severe graft-versus-host disease (GVHD) and graft failure. We tested a new approach to find out whether lymphohaemopoietic graft-versus-host reactions could occur without excessive GVHD in mixed haemopoietic chimeras produced across HLA barriers with non-myeloablative conditioning. Methods. Five patients with refractory non-Hodgkin lymphoma underwent bone-marrow transplantation from haploidentical related donors sharing at least one HLA A, B, or DR allele on the mismatched haplotype. Conditioning included cyclophosphamide and thymic irradiation before transplantation, and antithymocyte globulin before and after transplantation. The only other GVHD prophylaxis was cyclosporin. Findings. Four of five patients were evaluable and showed engraftment. Mixed haemopoietic chimerism was established, with a predominance of donor lymphoid tissue and varying degrees of myeloid chimerism. Two patients were in GVHD-free states of complete and partial clinical remission at 460 and 103 days after bone-marrow transplantation. Interpretation. Mixed chimerism can be induced in adult recipients of HLA-mismatched bone-marrow transplantation by a non-myeloablative conditioning regimen. The antilymphoma responses seen in two patients suggest that allogeneic bone-marrow transplantation without myeloablative conditioning might have potent immunotherapeutic benefits.
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页码:1755 / 1759
页数:5
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