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Umbilical Cord Blood Cytomegalovirus Serostatus Does Not Have an Impact on Outcomes of Umbilical Cord Blood Transplantation for Acute Leukemia. Biol Blood Marrow Transplant 2017; 23:1729-1735. [DOI: 10.1016/j.bbmt.2017.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/28/2017] [Indexed: 01/27/2023]
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González-Llano O, Rodríguez-Romo LN, Mancías-Guerra MDC, Tarín-Arzaga L, Jaime-Pérez JC, Herrera-Garza JL, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, García-Sepúlveda RD, García-Marín AY, Villarreal-Martínez L, Salazar-Riojas MDR, Gómez-Almaguer D. Feasibility of an outpatient HLA haploidentical stem cell transplantation program in children using a reduced-intensity conditioning regimen and CD3–CD19 depletion. Hematology 2013; 19:10-7. [DOI: 10.1179/1607845413y.0000000088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Oscar González-Llano
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Laura Nelly Rodríguez-Romo
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | | | - Luz Tarín-Arzaga
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - José Carlos Jaime-Pérez
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - José Luis Herrera-Garza
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Olga Graciela Cantú-Rodríguez
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - César Homero Gutiérrez-Aguirre
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ricardo Daniel García-Sepúlveda
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ana Yuritzen García-Marín
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Laura Villarreal-Martínez
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - María del Rosario Salazar-Riojas
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - David Gómez-Almaguer
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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Mateos MK, O’Brien TA, Oswald C, Gabriel M, Ziegler DS, Cohn RJ, Russell SJ, Barbaric D, Marshall GM, Trahair TN. Transplant-related mortality following allogeneic hematopoeitic stem cell transplantation for pediatric acute lymphoblastic leukemia: 25-year retrospective review. Pediatr Blood Cancer 2013; 60:1520-7. [PMID: 23733511 PMCID: PMC3798104 DOI: 10.1002/pbc.24559] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/15/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Over the last 25 years, donor source, conditioning, graft-versus-host disease prevention and supportive care for children undergoing hematopoeitic stem cell transplantation (HSCT) have changed dramatically. HSCT indications for acute lymphoblastic leukemia (ALL) now include high-risk patients in first and subsequent remission. There is a large burden of infectious and pre-HSCT morbidities, due to myelosuppressive therapy required for remission induction. We hypothesized that, despite these trends, overall survival (OS) had increased. PROCEDURE A retrospective audit of allogeneic pediatric HSCT for ALL was performed in our institution over 25 years. Outcomes for 136 HSCTs were analyzed in three consecutive 8-year periods (Period 1: 1/1/1984-31/8/1992, Period 2: 1/9/1992-30/4/2001, Period 3: 1/5/2001-31/12/2009). RESULTS Despite a significant increase in unrelated donor HSCT, event-free and OS over 25 years improved significantly. (EFS 31.6-64.8%, P = 0.0027; OS 41.8-78.9%, P < 0.0001) Concurrently, TRM dropped from 33% to 5% (P = 0.0004) whilst relapse rate was static (P = 0.07). TRM reduced significantly for matched sibling and unrelated cord blood transplantation (UCT) in Period 3 compared with earlier periods (P = 0.036, P = 0.0098, respectively). Factors leading to improved survival in patients undergoing UCT include better matching, higher total nucleated cell doses, and significantly faster neutrophil engraftment. Length of initial HSCT admission was similar over time. CONCLUSION EFS and OS have increased significantly despite heightened HSCT complexity. This survival gain was due to TRM reduction. Contemporary patients have benefited from refined donor selection and improved supportive care. Overall rates of leukemic relapse post-HSCT are unchanged, and remain the focus for improvement.
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Affiliation(s)
- Marion K Mateos
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia,School of Women and Children’s Health, University of New South WalesNSW, Australia
| | - Tracey A O’Brien
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia,School of Women and Children’s Health, University of New South WalesNSW, Australia
| | - Cecilia Oswald
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia
| | | | - David S Ziegler
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia,School of Women and Children’s Health, University of New South WalesNSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia,School of Women and Children’s Health, University of New South WalesNSW, Australia
| | - Susan J Russell
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia,School of Women and Children’s Health, University of New South WalesNSW, Australia
| | - Draga Barbaric
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia,School of Women and Children’s Health, University of New South WalesNSW, Australia
| | - Toby N Trahair
- Kids Cancer Centre, Sydney Children’s HospitalRandwick, NSW, Australia,School of Women and Children’s Health, University of New South WalesNSW, Australia,* Correspondence to: Toby N. Trahair, Pediatric Hematologist/Oncologist Sydney Children’s Hospital, Randwick, NSW, Australia 2031., E-mail:
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Palma J, Salas L, Carrión F, Sotomayor C, Catalán P, Paris C, Turner V, Jorquera H, Handgretinger R, Rivera GK. Haploidentical stem cell transplantation for children with high-risk leukemia. Pediatr Blood Cancer 2012; 59:895-901. [PMID: 22238059 DOI: 10.1002/pbc.24022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/03/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Chilean population is ethnically diverse, and more than 50% of children referred for hematopoietic stem cell transplantation (HSCT) lack a suitable donor. PROCEDURE To expand the donor pool, we assessed the feasibility, tolerance, and efficacy of using a haploidentical (HI) donor and a reduced-intensity conditioning regimen for high-risk pediatric leukemia. This study was facilitated by technology transfer from St. Jude Children's Research Hospital over the 2 preceding years. RESULTS Between March 2006 and April 2009, 10 patients (median age, 9.8 years) received T cell-depleted grafts at Calvo Mackenna Hospital in Santiago. Median cell doses were CD34+: 7.45 × 10(6)/kg (range, 4.00-20.20 × 10(6)/kg); CD3+: 0.88 × 10(5)/kg (0.11-1.35 × 10(5)/kg); and CD56+: 71.30 × 10(6)/kg (31.50-131.80 × 10(6)/kg). Nine patients experienced complete engraftment; six of the nine remain alive and clinically well 13-50 months post-HSCT. Three patients died after bone marrow relapse, while only one died of transplant-related causes. Virus reactivation was the main post-transplant complication: 5/10 had positive CMV PCR but none had CMV disease. One patient developed acute GvHD > grade II and only one had chronic GvHD. CONCLUSIONS HI-HSCT is feasible in our setting, offers a rational treatment option, and expands the donor pool significantly for children with high-risk leukemia in a developing country. This information is especially relevant to other ethnically diverse populations that are poorly represented in international donor registries.
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Affiliation(s)
- Julia Palma
- Bone Marrow Transplant Unit, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile.
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High success rate of hematopoietic cell transplantation regardless of donor source in children with very high-risk leukemia. Blood 2011; 118:223-30. [PMID: 21613256 DOI: 10.1182/blood-2011-01-333070] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated 190 children with very high-risk leukemia, who underwent allogeneic hematopoietic cell transplantation in 2 sequential treatment eras, to determine whether those treated with contemporary protocols had a high risk of relapse or toxic death, and whether non-HLA-identical transplantations yielded poor outcomes. For the recent cohorts, the 5-year overall survival rates were 65% for the 37 patients with acute lymphoblastic leukemia and 74% for the 46 with acute myeloid leukemia; these rates compared favorably with those of earlier cohorts (28%, n = 57; and 34%, n = 50, respectively). Improvement in the recent cohorts was observed regardless of donor type (sibling, 70% vs 24%; unrelated, 61% vs 37%; and haploidentical, 88% vs 19%), attributable to less infection (hazard ratio [HR] = 0.12; P = .005), regimen-related toxicity (HR = 0.25; P = .002), and leukemia-related death (HR = 0.40; P = .01). Survival probability was dependent on leukemia status (first remission vs more advanced disease; HR = 0.63; P = .03) or minimal residual disease (positive vs negative; HR = 2.10; P = .01) at the time of transplantation. We concluded that transplantation has improved over time and should be considered for all children with very high-risk leukemia, regardless of matched donor availability.
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Hough R, Cooper N, Veys P. Allogeneic haemopoietic stem cell transplantation in children: what alternative donor should we choose when no matched sibling is available? Br J Haematol 2009; 147:593-613. [PMID: 19709086 DOI: 10.1111/j.1365-2141.2009.07841.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Allogeneic haemopoietic stem cell transplantation has provided curative therapy for life-threatening malignant and non-malignant diseases in children for over 40 years. Only 25% of children in whom an allograft is indicated have the ideal option of a human leucocyte antigen-identical sibling donor. Substantial advances in the use of alternative donors (unrelated volunteer donors, haploidentical family donors and unrelated umbilical cord blood donors) now make it possible for almost all children to benefit from this life-saving treatment. Each donor choice is associated with distinct advantages and disadvantages, which have greater or lesser importance in different diseases. We review the current status of alternative donor transplantation for haematological malignancies, primary immunodeficiencies, inherited metabolic disorders and bone marrow failure syndromes and outline the current UK consensus donor selection algorithms for these disease groups.
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Early (Day −7) versus Conventional (Day −1) Inception of Cyclosporine-A for Graft-versus-Host Disease Prophylaxis after Unrelated Donor Hematopoietic Stem Cell Transplantation in Children. Long-Term Results of an AIEOP Prospective, Randomized Study. Biol Blood Marrow Transplant 2009; 15:741-8. [DOI: 10.1016/j.bbmt.2009.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 03/06/2009] [Indexed: 11/22/2022]
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Pulsipher MA, Bader P, Klingebiel T, Cooper LJN. Allogeneic transplantation for pediatric acute lymphoblastic leukemia: the emerging role of peritransplantation minimal residual disease/chimerism monitoring and novel chemotherapeutic, molecular, and immune approaches aimed at preventing relapse. Biol Blood Marrow Transplant 2009; 15:62-71. [PMID: 19147081 DOI: 10.1016/j.bbmt.2008.11.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although improved donor sources and supportive care have decreased transplantation-related mortality over the past decade, relapse remains the principal cause of failure after allogeneic transplantation for high-risk pediatric acute lymphoblastic leukemia (ALL). Emerging tools of minimal residual disease (MRD) and chimerism monitoring before and after transplantation have defined those children at highest risk for relapse and provide the opportunity for intervention to prevent relapse. Specific methods aimed at decreasing relapse include the use of intensive treatment before transplantation to increase the percentage of patients undergoing the procedure with negative MRD, optimal transplantation preparative regimens, and posttransplantation interventions with targeted or immunologic therapy. Early data demonstrate decreased relapse with the use of sirolimus for all types of ALL and imatinib for ALL with the Philadelphia chromosome (Ph(+) ALL) after transplantation. Patients with increasing chimerism or MRD have been shown to benefit from early withdrawal of immune suppression or donor lymphocyte infusion. Finally, various targeted immunologic therapies, including monoclonal antibodies, killer cell immunoglobulin-like receptor mismatching, natural killer cell therapy, and targeted T cell therapies, are emerging that also could have an affect on relapse and improve survival after transplantation for pediatric ALL.
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Affiliation(s)
- Michael A Pulsipher
- Division of Hematology/BMT, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, Utah
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