Blood Journal
Leading the way in experimental and clinical research in hematology

HLA-haploidentical bone marrow transplantation with post-transplant cyclophosphamide expands the donor pool for patients with sickle cell disease

  1. Javier Bolaños-Meade1,*,
  2. Ephraim J. Fuchs1,
  3. Leo Luznik1,
  4. Sophie M. Lanzkron2,
  5. Christopher J. Gamper3,
  6. Richard J. Jones1, and
  7. Robert A. Brodsky2
  1. 1 Hematologic Malignancies and Bone Marrow Transplantation Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center and Johns Hopkins University School of Medicine, Baltimore, MD, United States;
  2. 2 Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States;
  3. 3 Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center and Johns Hopkins University School of Medicine, Baltimore, MD, United States
  1. * Corresponding author; email: fbolano2{at}jhmi.edu

Abstract

Allogeneic marrow transplantation can cure sickle cell disease; however, HLA-matched donors are difficult to find, and the toxicities of myeloablative conditioning are prohibitive for most adults with this disease. We developed a non-myeloablative bone marrow transplantation platform using related, including HLA-haploidentical, donors for patients with sickle cell disease. The regimen consisted of anti-thymocyte globulin, fludarabine, cyclophosphamide and total body irradiation, and graft-versus-host disease prophylaxis with post-transplantation high dose cyclophosphamide, mycophenolate mofetil and tacrolimus or sirolimus. After screening 19 patients, we transplanted 17, 14 from HLA-haploidentical and three from HLA-matched related donors. Eleven patients engrafted durably. With a median follow up of 711 days (minimal follow up 224 days), 10 patients are asymptomatic, and six patients are off immunosupression. Only one patient developed skin-only acute graft-versus-host disease that resolved without any therapy, no mortality was seen. Non-myeloablative conditioning with post-transplantation high dose cyclophosphamide expands the donor pool making marrow transplantation feasible for most patients with sickle cell disease and is associated with a low risk of complications, even with haploidentical related donors. Graft failure, 43% in haploidentical pairs, remains a major obstacle, but may be acceptable in a fraction of patients if the majority can be cured without serious toxicities.

  • Submitted July 2, 2012.
  • Accepted August 20, 2012.