Almudena de Laiglesia

Haematopoietic transplants combining a single unrelated cord blood unit and mobilized haematopoietic stem cells from an adult HLA-mismatched third party donor. Comparable results to transplants from HLA-identical related donors in adults with acute leukaemia and myelodysplastic syndromes.

We describe results of the strategy, developed by our group, of co-infusion of mobilized haematopoietic stem cells as a support for single-unit unrelated cord blood transplant (dual CB/TPD-MHSC transplants) for treatment of haematological malignancies in adults, and a comparative analysis of results obtained using this strategy and transplants performed with mobilized haematopoietic stem cells from related HLA-identical donors (RTD) for treatment of adults with acute leukaemia and myelodysplastic syndromes. Our data show that the dual CB/TPD-MHSC transplant strategy results in periods of post-transplant neutropenia, final rates of full donor chimerism and transplant-related mortality rates comparable to those of the RTD. Final survival outcomes are comparable in adults transplanted because of acute leukaemia, with different incidences of the complications that most influence these: a higher incidence of infections related to late recovery of protective immunity dependent on T cell functions, and a lower incidence of serious acute graft-versus-host disease and relapses. Recent advances in cord blood transplant techniques allow allogeneic haematopoietic stem cell transplantation (HSCT) to be a viable option for almost every patient who may benefit from this therapeutic approach. Development of innovative strategies to improve the post-transplant recovery of T cells function is currently the main challenge to further improving the possibilities of unrelated cord blood transplantation.

Rhodotorula species fungaemia causes low mortality in haematopoietic stem-cell transplantation. A case report and review.

Rafael Forés, Antonio Ramos, Beatriz Orden, Almudena de Laiglesia, Guiomar Bautista, Martı́n Cabero, Elena Muñez, Isabel Sánchez-Romero, Belén Navarro, Julio Bravo and Rafael Cabrera Department of Hematology, Hospital Universitario Puerta de Hierro, 28220 Majadahonda, Madrid, Spain, Department of Internal Medicine (Infectious Disease Unit), Hospital Universitario Puerta de Hierro, 28220 Majadahonda, Madrid, Spain and Department of Microbiology, Hospital Universitario Puerta de Hierro, 28220 Majadahonda, Madrid, Spain

HLA‐partially matched cellular therapy (stem‐cell microtransplantation) for acute myeloid leukaemia: description of four cases

Donor leucocyte infusions (DLI) after conventional chemotherapy have been proposed as a treatment for acute myeloid leukaemia (AML). This procedure has been successfully employed in AML elderly patients (Guo et al, 2011; Cignetti et al, 2013), low and intermediate-risk AML as post-remission therapy (Guo et al, 2012) and myelodysplastic syndromes (MDS) (Ai et al, 2012). In our centre, using a similar approach, we have performed nine human leucocyte antigen (HLA)-partially matched donor leucocyte infusions (PM-DLI) in four elderly patients, three of which were HLA-haploidentical (Table I). After obtaining institutional ethics approval, one or two apheresis of related donor peripheral mononuclear cells were collected after granulocyte colony-stimulating factor (filgrastim) mobilization. The procedure was employed as post-remission therapy in three cases (2 de novo intermediate-risk AML and 1 post-essential thrombocythaemia JAK2-positive AML with high risk cytogenetics); all of them received 2 cytarabine cycles (1 g/m/12 h intravenously days +1, +3 and +5) following PM-DLI at day +7. The remaining patient, with AML secondary to MDS (refractory cytopenia with multilineage dysplasia), received one PM-DLI after the induction course (5-azacitidine 100 mg/m/d subcutaneously for 5 d following cytarabine 100 mg/m/d for 7 d plus idarubicin 12 mg/m/d for 3 d) with prolonged cytopenias and circulating blasts. Subsequently, he received two more courses of 5-azacitidine (100 mg/m/d for 5 d) following PM-DLI, achieving complete remission after the first course. The median numbers of mononuclear, CD34+ and CD3+ cells infused per course were 3 57 9 10/kg (range 1 7– 5 43 9 10/kg), 3 19 9 10/kg (range 1 05–6 58 9 10/kg) and 1 42 9 10/kg (range 0 35–2 42 9 10/kg ), respectively.

Busulfan-based myeloablative conditioning regimens for haploidentical transplantation in high-risk acute leukemias and myelodysplastic syndromes

High‐risk acute leukemia (AL) and myelodysplastic syndrome (MDS) remain a therapeutic challenge. Unmanipulated haploidentical‐related donor transplantation based on a myeloablative conditioning regimen (HAPLO‐MAC) and post‐transplant cyclophosphamide (PT‐Cy) as prophylaxis against graft vs host disease (GvHD) is now a promising rescue strategy that could become universally available.