1. Haploidentical hematopoietic cell and kidney transplantation for hematological malignancies and end-stage renal failure
- Author
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Eliot Heher, Shuli Li, Bimalangshu R. Dey, David H. Sachs, Nina Tolkoff-Rubin, Nahel Elias, Winfred W. Williams, Jay A. Fishman, Zachariah DeFilipp, Areej El-Jawahri, A. Benedict Cosimi, Tatsuo Kawai, Paul O'Donnell, Candice Del Rio, Kerry Collier, Yi Bin Chen, Thomas R. Spitzer, Steven L. McAfee, and Jeannine S. McCune
- Subjects
Adult ,Male ,medicine.medical_specialty ,Transplantation Conditioning ,Cyclophosphamide ,medicine.medical_treatment ,Immunology ,Pilot Projects ,Biochemistry ,Gastroenterology ,Postoperative Complications ,immune system diseases ,Internal medicine ,medicine ,Humans ,Dialysis ,Multiple myeloma ,Kidney transplantation ,Aged ,Transplantation ,business.industry ,Hematopoietic Stem Cell Transplantation ,Cell Biology ,Hematology ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Fludarabine ,surgical procedures, operative ,Graft-versus-host disease ,Hematologic Neoplasms ,Transplantation, Haploidentical ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business ,medicine.drug - 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.
- Published
- 2019
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