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Qasim W, Cavazzana-Calvo M, Davies E, Davis J, Duval M, Eames G, Farinha N, Filopovich A, Fischer A, Friedrich W, Gennery A, Heilmann C, Landais P, Horwitz M, Porta F, Sedlacek P, Seger R, Slatter M, Teague L, Eapen M, Veys P, Veys P. Allogeneic hematopoietic stem-cell transplantation for leukocyte adhesion deficiency. Pediatrics 2009; 123:836-40. [PMID: 19255011 PMCID: PMC3380632 DOI: 10.1542/peds.2008-1191] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Leukocyte adhesion deficiency is a rare primary immune disorder caused by defects of the CD18 beta-integrin molecule on immune cells. The condition usually presents in early infancy and is characterized by deep tissue infections, leukocytosis with impaired formation of pus, and delayed wound healing. Allogeneic hematopoietic stem-cell transplantation offers the possibility of curative therapy, and with patient numbers at any individual center being limited, we surveyed the transplant experience at 14 centers worldwide. METHODS The course of 36 children with a confirmed diagnosis of leukocyte adhesion deficiency who underwent hematopoietic stem-cell transplantation between 1993 and 2007 was retrospectively analyzed. Data were collected by the registries of the European Society for Immunodeficiencies/European Group for Blood and Marrow Transplantation, and the Center for International Blood and Marrow Transplant Research. RESULTS At a median follow-up of 62 months (extending to 14 years), the overall survival rate was 75%. Myeloablative conditioning regimens were used in 28 patients, and reduced-intensity conditioning in 8 patients, with no deaths in this subgroup. Survival rates after matched family donor and unrelated donor transplants were similar, with 11 of 14 matched family donor and 12 of 14 unrelated donor recipients alive; mortality was greatest after haploidentical transplants, after which 4 of 8 children did not survive. Twenty-seven transplant recipients were alive, with full donor engraftment in 17 cases, mixed multilineage chimerism in 7 patients, and mononuclear cell-restricted chimerism in an additional 3 cases. CONCLUSIONS Hematopoietic stem-cell transplantation offers long-term benefit in leukocyte adhesion deficiency and should be considered as an early therapeutic option if a suitable HLA-matched stem-cell donation is available. Reduced-intensity conditioning was particularly safe, and mixed-donor chimerism seems sufficient to prevent significant symptoms, although careful long-term monitoring will be required for these patients.
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Affiliation(s)
- Waseem Qasim
- Great Ormond Street Hospital and Institute of Child Health, 30 Guilford St, London WC1N 1EH, United Kingdom.
| | | | - E.Graham Davies
- Great Ormond Street Hospital, 30 Guilford Street, London, WC1N 1EH
| | - Jeffery Davis
- British Columbia Children’s Hospital, Vancouver, Canada
| | - Michel Duval
- Hopital Sainte Justine, Service d’Hemato-Oncologie, Montreal, Canada
| | | | - Nuno Farinha
- Hematology & Oncology Unit, Hospital de S. Joao, Al.Hernani Monteiro, Porto
| | - Alexandra Filopovich
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio
| | - Alain Fischer
- Hôpital Necker Enfants Malades, 149, rue de Sèvres, 75743 Paris, France
| | | | - Andrew Gennery
- Newcastle General Hospital, Westgate Road, NE46BE Newcastle-upon-Tyne, United Kingdom
| | | | - Paul Landais
- Hôpital Necker Enfants Malades, 149, rue de Sèvres, 75743 Paris, France
| | | | - Fulvio Porta
- Universitá degli Studi di Brescia, Spedali Civili, P.le Spedali Civili, 25123 Brescia, Italy
| | - Petr Sedlacek
- University Hospital Motol, V Uvalu, 84, 150 06 Prague, Czech Republic
| | - Reinhard Seger
- University Children’s Hospital, Div. Immunology/Hematology/Oncology, Steinwiesstr. 75, CH-8032 Zürich, Switzerland
| | - Mary Slatter
- Newcastle General Hospital, Westgate Road, NE46BE Newcastle-upon-Tyne, United Kingdom
| | | | - Mary Eapen
- CIBMTR Statistical Center, Medical College of Wisconsin, Milwaukee WI 53226
| | - Paul Veys
- Great Ormond Street Hospital, 30 Guilford Street, London, WC1N 1EH
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