Haploidentical bone marrow transplantation for treatment of patients with aggressive and refractory non-Hodgkin's lymphoma

Objective:To explore the feasibility of haploidentical bone marrow transplantation in which the donors received granulocyte colony-stimulating factor(G-CSF) prior to harvest and five immunosuppressive agents were added to recipients for treatment of patients with aggressive and refractory non-Hodgkin's lymphoma. Method:Six patients with aggressive and refractory non-Hodgkin's lymphoma received Allo-BMT from HLA two or three loci mismatched related donors.The donors of patients were given G-CSF (Lenograstim Chugai) 250 ug/day for seven days prior to marrow harvest.Patient 1 received CSA?MTX ?ATG and Mycophenolate mofetil (MMF) for GVHD prophylaxis. The remainder 5 patients added CD25 monoclonal antibody (Simulect,Novartis Pharma Switzerland) with CSA, MTX, ATG and MMF for GVHD prophylaxis. A total 40 mg was given in two doses of 20 mg each by 30 min intravenous infusion on 2 h before transplantation and day 4 after transplantation. Results:All patients were engrafted. The median day of granulocytes exceeding 0.5×109/L and platelets exceeding 20×109/L were day 17 and 22.All patients had 100% donors hematopoietic cells after transplantation by cytogenetic evidence analysis . One of six patients experienced grade Ⅳ acute GVHD. Four patients evaluated for chronic GVHD experienced chronic GVHD. One patient developed clinical extensive cGVHD which responded to the administration of steroids and CSA. The median follow-up duration of patients was 20 months(range 7～42 months), two patients died from transplant-related mortality(1 from acute GVHD,1 from fungal infection) and four patients were alive in disease free situation. The survival patients had Karnofsky clinical performance status of 100%. Conclusion:The transplants from haploidentical donor used in this study for treatment of patients with aggressive and refractory non-Hodgkin's lymphoma is effective on preventing acute severe GVHD and may reduce transplant-related mortality.