Jurnal Internasional Sel hematopoietik haploidentik dan transplantasi ginjal untuk keganasan hematologis dan gagal ginjal stadium akhir
At Massachusetts General Hospital, we pioneered simultaneous hematopoietic cells (HCT) / simultaneous kidney transplants from HLA-related donors for the treatment of haematological malignancies with end-stage renal failure. We have now extended this to HLA-haploidentical donors in pilot trials. Six recipients, 5 of which were conditioned with fludarabine, cyclophosphamide, and total-body irradiation, underwent a combined HCT / kidney transplant from a haploidentical donor; prophylaxis of graft-versus-host disease (GVHD) includes post-HCT cyclophosphamide, tacrolimus, and mycophenolate mofetil. One patient died due to complications from fludarabine neurological toxicity. No neurological toxicity was observed in subsequent patients who received a lower dose of fludarabine and more intense postfludarabine dialysis. There were no cases of acute GVHD grade 2 to 4 and 1 case of chronic GVHD moderate at 12 months. One patient experienced multiple myeloma recurrence at 30 months after HCT and died 4 years after transplantation. Overall, 4 of 6 patients remained alive, without disease recurrence and with long-term free kidney rejection survival. This trial is listed at www.clinicaltrials.gov as # NCT01758042.