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Bernard F, Uppungunduri CRS, Meyer S, Cummins M, Patrick K, James B, Skinner R, Tewari S, Carpenter B, Wynn R, Veys P, Amrolia P. Excellent overall and chronic graft-versus-host-disease-free event-free survival in Fanconi anaemia patients undergoing matched related- and unrelated-donor bone marrow transplantation using alemtuzumab-Flu-Cy: the UK experience. Br J Haematol 2021; 193:804-813. [PMID: 33855694 DOI: 10.1111/bjh.17418] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/20/2022]
Abstract
Haematopoietic stem cell transplantation (HSCT) remains the only curative option in Fanconi anaemia (FA). We analysed the outcome of children transplanted for FA between 1999 and 2018 in the UK. A total of 94 transplants were performed in 82 patients. Among the donors, 51·2% were matched related donors (MRD) while the remainder were alternative donors. Most patients received a fludarabine-cyclophosphamide (Flu-Cy)-based conditioning regimen (86·6%) and in vivo T-cell depletion with alemtuzumab (69·5%). Five-year overall survival (OS) was 85·4% [70·4-93.2] with MRD, 95·7% [72·9-99.4] with matched unrelated donors (MUD), 44·4% [6·6-78.5] with mismatched unrelated donors (MMUD) and 44·4% [13·6-71.9] with mismatched related donors (MMRD) (P < 0·001). Other factors significantly impacting OS were pre-transplant bone marrow status, source of stem cells, cytomegalovirus (CMV) serostatus, preparation with Flu-Cy, use of total body irradiation (TBI) and alemtuzumab as serotherapy. In multivariate analysis, absence of myelodysplastic syndrome (MDS) or leukaemia, bone marrow as source of stem cells, cytomegalovirus (CMV) other than +/- (Recipient/Donor) and Flu-Cy were protective factors for five-year OS. Five-year chronic graft-versus-host-disease (cGVHD)-free event-free survival was 75·4% with the same risk factors except for CMV serostatus. Five-year non-relapse mortality was 13·8% [7·3-22.3]. Only five patients (6·1%) developed grade II-IV acute GVHD and two patients chronic GVHD. These data confirm the excellent outcome of matched related or unrelated HSCT in children with FA.
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Affiliation(s)
- Fanette Bernard
- Paediatric Onco-Haematology Unit, Geneva University Hospital, Geneva, Switzerland
| | | | - Stephan Meyer
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Teenage and Young Adult Cancer, The Christie NHS Foundation Trust, Manchester, UK.,Department of Haematology and Oncology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Cummins
- Department of Paediatric Haematology and Bone Marrow Transplantation, Bristol Royal Hospital for Children, Bristol, UK
| | - Katharine Patrick
- Department of Paediatric Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - Beki James
- Department of Paediatric Oncology and Haematology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Sanjay Tewari
- Department of Paediatric Haematology/Oncology, The Royal Marsden Hospital NHS Trust, Sutton, UK
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals NHS Trust, London, UK
| | - Robert Wynn
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paul Veys
- Department of Bone Marrow Transplant and Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Persis Amrolia
- Department of Bone Marrow Transplant and Haematology, Great Ormond Street Hospital for Children, London, UK.,Molecular and Cellular Immunology Section, UCL Great Ormond Street Institute of Child Health, London, UK
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