To know the real figure of hematopoietic stem cell donation for further development of donors' safety and satisfaction, we analyzed family donors' opinions which were collected through nation-wide family donor annual follow up system conducted by Japan Society for Hematopoietic Cell Transplantation (JSHCT) between April , 2006 and March, 2010. The outcomes were then compared between bone marrow (BM) donors and peripheral blood stem cell (PBSC) donors. The ratio of satisfaction (dissatisfaction) after the donation was not different between BM and PBSC donors nevertheless, physical complaints with dissatisfaction were significantly higher among BM donors. Major physical complaint was pain, especially unexpectedly prolonged pain due to marrow aspiration which was assumed to be improved by the development of harvest techniques, of devices such as the size of needles and by further concerns of harvest teams to donors.
The optimal candidates and timing for allogeneic stem cell transplantation (allo-SCT) in patients with primary myelofibrosis (PMF) and secondary myelofibrosis (sMF) are unknown. We retrospectively examined the outcomes of PMF (n=13) and sMF (n=8)patients who underwent allo-SCT between 1997 and 2008. The median age at transplantation was 50 years (range, 21-60). Thirteen subjects (61.9%) received myeloablative conditioning. The source of hematopoietic cells was HLA-matched related (52.3%), -matched unrelated (33.3%), or -mismatched unrelated (9.5%) donors. All patients achieved engraftment, and the median time to neutrophil and platelet recovery was 19 (range, 13-36) and 75 (range, 15-411) days, respectively. With a median follow-up of 16.7(range, 1-134) months, overall survival (OS) at 60 months was 55.6% (95% CI, 34.0-77.0%). No significant differences in OS were observed between PMF and sMF patients and between myeloablative and reduced-intensity conditioning. HLA-mismatched donors, lower platelet count (<10×10 4 /μl), and previous blastic transformation were associated with a significantly worse prognosis. These data suggest that allo-SCT with myeloablative or reduced-intensity conditioning is potentially effective for PMF and sMF patients aged <60 years. However, a platelet count of <10×10 4 /μl is a strong adverse factor.
Pure red cell aplasia (PRCA) and Evans syndrome following allogeneic hematopoietic stem cell transplantation (HSCT) from a blood type-matched donor are very rare. A 29-year-old Japanese woman with hematologic remission of Philadelphia chromosomepositive acute lymphoblastic leukemia underwent bone marrow transplantation from a blood type-matched, HLA 6/6 ― matched, unrelated donor in May 2008. Her clinical course after transplantation was favorable, and allowed for a gradual reduction in tacrolimus dosage. However, 12 months after transplantation, she developed PRCA related to allogeneic HSCT. The patientʼs PRCA was alleviated by stopping the dosage reduction for the immunosuppressive therapy and by continued administration of lowdose tacrolimus. Three months after the PRCA diagnosis, the patient developed Evans syndrome, so prednisolone (PSL) treatment was initiated. PSL treatment effectively treated the Evans syndrome, as was evident by the absence of cythemolysis two months later, and no relapse has occurred even after the PSL dose was reduced and then terminated. The fact that PRCA onset in this case occurred after blood type-matched allogeneic HSCT, during the late grafting phase, and in combination with Evans syndrome, suggests that the pathogenic mechanism may differ from that of previously reported cases of PRCA following blood type-incompatible allogeneic HSCT.
High dose chemotherapy followed by autologous stem cell transplantation (SCT) has been shown to be effective therapy for patients with relapsed lymphoma responsive to standard-dose salvage chemotherapy. Here we report a patient in second complete remission(CR) from relapsed follicular lymphoma (grade 3) who was successfully treated with peripheral blood stem cells (PBSC) that had been harvested in first CR 10 years before. One of six frozen bags was thawed and submitted for progenitor cell assays. Because the number of progenitors was considered to be sufficient for engraftment, autologous SCT was performed without further stem cell harvest. At infusion, the viability of all nucleated cells (ANC) of the 5 remaining bags was 61.4%. She was expected to receive 2.87×10 8 /kg of ANC, 4.43×10 6 /kg of CD34 + cells and 32.3×10 4 /kg of CFU-GM based on the numbers obtained before cryopreservation. She achieved a granulocyte count>500/mm 3 on day 10 and a self-supporting platelet count>20×10 3 /mm 3 on day 12. She remains disease-free for 3.5 years. This successful case suggests that PBSC may be harvested at an early time point before significant stem cell damage due to chemotherapy and radiotherapy and stored for several years.
A 41 ―year-old Japanese man with Philadelphia chromosome-positive acute lymphoblastic leukemia received allogeneic hematopoietic stem cell transplantation (allo-HSCT) from a human leukocyte antigen (HLA)-matched unrelated donor at molecular complete remission. Although bone marrow engraftment was successful, he required frequent red blood cell transfusions due to pure red cell aplasia following transplantation. He developed a high ferritinemia (4960 ng/ml) and secondary hemochromatosis and was treated with deferasirox for iron overload following allo-HSCT. After 10 months of iron chelation therapy, the serum ferritin level decreased to 575 ng/ml, serum aminotransferases returned to normal values, and magnetic resonance imaging revealed improvements in abnormal findings in the liver. Liver dysfunction after allo-HSCT was initially considered to be chronic graft-versus-host disease but actually occurred due to hepatic hemochromatosis. These results suggested that iron-chelating therapy with deferasirox is useful for patients presenting with iron overload following allo-HSCT.