TY - JOUR T1 - Hematopoietic cell transplantation from an HLA-mismatched familial donor is feasible without ex vivo-T cell depletion after reduced-intensity conditioning with busulfan, fludarabine, and antithymocyte globulin. AU - Lee,Kyoo-Hyung, AU - Lee,Je-Hwan, AU - Lee,Jung-Hee, AU - Kim,Dae-Young, AU - Kim,Se-Hyung, AU - Shin,Ho-Jin, AU - Lee,Young-Shin, AU - Kang,Young-Ah, AU - Seol,Miee, AU - Ryu,Sung-Gil, PY - 2008/09/08/received PY - 2008/10/28/accepted PY - 2009/1/13/entrez PY - 2009/1/13/pubmed PY - 2009/2/28/medline SP - 61 EP - 72 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 15 IS - 1 N2 - To extend the use of allogeneic hematopoietic cell transplantation (HCT) to patients without an HLA-matched donor, we investigated HCT from a related donor with 1 fully mismatched HLA-haplotype after conditioning with busulfan in reduced-dose, fludarabine, and antithymocyte globulin. Hematopoietic cells were collected from the donors via leukapheresis after mobilization and infused without further manipulation. Cyclosporin and methotrexate were administered for graft-versus-host disease (GVHD) prophylaxis. Posttransplant engraftment, GVHD, and transplantation-related mortality (TRM) were recorded. Thirty-one patients (age range: 16-69 years) with high-risk acute leukemia/myelodysplastic syndrome (n = 25) or bone marrow failure (n = 6) were enrolled. The donors were either mothers (n = 14), offspring (n = 9), or siblings (n = 8) of these patients. Excluding 3 patients who died or relapsed with leukemia within 3 weeks after HCT, all the remaining 28 patients engrafted with neutrophils (>500/microL) at a median of 16.5 days. Twenty-two of 24 evaluated patients achieved complete donor chimerism (> or =95%) 2 weeks after HCT and none experienced graft failure subsequently. The cumulative incidences of grade 2-4 acute GVHD (aGVHD) and moderate-severe chronic GVHD (cGVHD) were 19% (95% confidence interval [CI], 9%-40%) and 20% (95% CI, 10%-41%), respectively. After a median follow-up of 18.2 months (range: 6.3-52.1), 18 patients remained alive (53%). Four patients died without recurrence/progression of underlying diseases giving a TRM of 13% (95% CI, 5%-33%). HCT from an HLA-mismatched family member is feasible without ex vivo T cell depletion when reduced-intensity conditioning containing anti-hymocyte globulin is performed. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/19135944/Hematopoietic_cell_transplantation_from_an_HLA_mismatched_familial_donor_is_feasible_without_ex_vivo_T_cell_depletion_after_reduced_intensity_conditioning_with_busulfan_fludarabine_and_antithymocyte_globulin_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(08)00474-6 DB - PRIME DP - Unbound Medicine ER -