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Blood. 2019 Jul 11;134(2):211-215. doi: 10.1182/blood.2019000775. Epub 2019 May 31.

Haploidentical hematopoietic cell and kidney transplantation for hematological malignancies and end-stage renal failure.

Author information

1
Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA.
2
Harvard Medical School, Boston, MA.
3
Division of Transplant Surgery and.
4
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
5
Fred Hutchinson Cancer Research Center, Seattle, WA.
6
Department of Pharmaceutics, University of Washington, Seattle, WA.
7
Dana-Farber Cancer Institute, Boston, MA.
8
Transplant Infectious Disease and Compromised Host Program, Massachusetts General Hospital, Boston, MA; and.
9
Center for Translational Immunology, Columbia University Medical Center, New York, NY.

Abstract

At Massachusetts General Hospital, we pioneered simultaneous hematopoietic cell (HCT)/kidney transplantation from HLA-identical related donors for the treatment of hematological malignancies with end-stage renal failure. We have now extended this to HLA-haploidentical donors in a pilot trial. Six recipients, 5 of whom were conditioned with fludarabine, cyclophosphamide, and total-body irradiation, underwent combined HCT/kidney transplantation from haploidentical donors; graft-versus-host disease (GVHD) prophylaxis included post-HCT cyclophosphamide, tacrolimus, and mycophenolate mofetil. One patient died as a result of complications of fludarabine neurological toxicity. No neurological toxicity was observed in subsequent patients who received lower fludarabine doses and more intense postfludarabine dialysis. There were no cases of grade 2 to 4 acute GVHD and 1 case of moderate chronic GVHD by 12 months. One patient experienced relapse of multiple myeloma at 30 months after HCT and died 4 years posttransplantation. Overall, 4 of 6 patients remain alive, without disease relapse and with long-term renal rejection-free survival. This trial was registered at www.clinicaltrials.gov as #NCT01758042.

PMID:
31151984
DOI:
10.1182/blood.2019000775

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