Sequential Transplantation Of Haploidentical Hematopoietic Stem Cell Followed By Unrelated Cord Blood For Children With Hematologic Malignancies

Backgroud:Post-transplanted Cyclophosphamide(PT/Cy)in haploidentical hematopoietic stem cell transplantation is a new protocol in Haplo-SCT formulated by NIH.Nanfang Pediatric Transplantation Center have already practice this protocol.But complication like cytopenia and relapse were still hard to avoid.Aim to change this phenomenon and improved the curative effect.We investigated a new prospective study which used a cord blood sequential transplantation after haplo-SCT on the base of PT/CyObjects:1.To explore whether cord blood sequential transplantation after haplo-SCT can reduce the non-relapse morality;2.To explore whether this new protocol reduce the relaspse rate compared with PT/Cy-haplo-SCT.3.To investigate how the high dose of haplo-TNC influence the hematopoiesis recovery.Method:Summurize our Children Transplantation Center 46 patients with hematological diseases who were finished the transplantation with or without cord blood post-transplanted.These 46 cases were separated into two groups:One is NF-10-PTCy,only the haploidentical transplantation(n=25).The other is NF-13-PTCy,with haploidentical and post-transplanted cord blood transplantation(n=21).We compared any aspects among these two groups as the overall survive time,disease-free survive time,relapse incidence,the NRM,applications and so on.Results:NF-13-PT/Cy compared to NF-10-PTCy on aGVHD,the result was 33%,44%。Among them Ⅱ～Ⅳ aGVHD was 29%,64%.cGVHD was 4.8%and 12%.Cytopenia was 14%and 40%.HC was 9.5%and 24%,Septicemia was 0%and 8%.The TRM、NRM and RM in NF-13-PTCy were 33.3%、23.8%、9.5%.The TRM、NRM and RM in NF-10-PTCy were 72%、40%、32%.The overall survive and disease-free survive in NF-13-PTCy were 66.7%,57.1%.However,The overall survive and disease-free survive in NF-10-PTCy were 28%,28%.Compared with these two groups,the P value on OS and DFS was 0.013 and 0.025.the OS and DFS have statistical significance.The NF-13-PT/Cy showed rapid hematopoietic recovery and cellular reconstitution.The protocol of NF-13-PT/Cy is advantage to NF-10-PT/Cy.Conclusion:Sequential Transplantation of Haploidentical Hematopoietic Stem Cell Combined with Unrelated Cord Blood for Children with Hematologic malignancies increase OS and DFS,reduce NRM.Even no meaning by comparison between two groups on RI,but the rate get lower in NF-13-PTCy.High dose of haplo-TNC was estimated not make GVHD increase.