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Mussetti A, Kernan NA, Prockop SE, Scaradavou A, Lehrman R, Ruggiero JM, Curran K, Kobos R, O’Reilly R, Boulad F. Allogeneic hematopoietic stem cell transplantation for nonmalignant hematologic disorders using chemotherapy-only cytoreductive regimens and T-cell-depleted grafts from human leukocyte antigen-matched or -mismatched donors. Pediatr Hematol Oncol 2016; 33:347-358. [PMID: 27715384 PMCID: PMC5175271 DOI: 10.1080/08880018.2016.1204399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/20/2022]
Abstract
Nonmalignant hematologic disorders (NMHD) of childhood comprise a variety of disorders, including acquired severe aplastic anemia and inherited marrow failure syndromes. Patients with high-risk NMHD without matched related donors fare poorly with allogeneic hematopoietic alternative donor stem cell transplantation (allo-HSCT) and are at high risk for developing graft-versus-host disease following unmodified grafts. The authors retrospectively analyzed data on 18 patients affected by NMHD, lacking a human leukocyte antigen (HLA)-identical sibling donor, who underwent an alternative donor allo-HSCT at their institution between April 2005 and May 2013. Fifty percent of the patients had received prior immunosuppressive therapy, 72% had a history of infections, and 56% were transfusion dependent at the time of transplant. Cytoreduction included a combination of 3 of 5 agents: fludarabine, melphalan, thiotepa, busulfan, and cyclophosphamide. Grafts were T-cell depleted. All evaluable patients engrafted. Five died of transplant complications. The cumulative incidence of graft-versus-host disease was 6%. No patient had recurrence of disease. Five-year overall survival was 77%. Age at transplant <6 years was strongly associated with better survival. Based on these results, transplant with chemotherapy-only cytoreductive regimens and T-cell-depleted stem cell transplants could be recommended for patients with high-risk NMHD, especially at a younger age.
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Affiliation(s)
- Alberto Mussetti
- Dipartimento di Ematologia e Onco-Ematologia Pediatrica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nancy A Kernan
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Susan E Prockop
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Andromachi Scaradavou
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Rachel Lehrman
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Julianne M Ruggiero
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kevin Curran
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Rachel Kobos
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Richard O’Reilly
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Farid Boulad
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY,Division of Pediatric Hematology/Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY
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Clark AL, Pozotrigo M, Mathew S, Liu D, Prockop SE, Ruggiero JM, Torok-Castanza J, Zakak N, Boulad F. Retrospective Evaluation of Palivizumab Efficacy and Safety for RSV Prophylaxis in Pediatric Hematopoietic Stem Cell Transplant Patients: A Single Center Experience. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kernan NA, Boulad F, Prockop SE, Scaradavou A, Kobos R, Lehrman R, Klein E, Wolden S, Curran KJ, Hasan AN, Bleau S, Ruggiero JM, Zakak N, Casson A, Torok-Castanza J, O'Reilly RJ. T- Cell Depleted Peripheral Blood Stem Cell (TCD-PBSC) Transplants Secure Consistent Engraftment with Low Risk of Acute or Chronic Gvhd and Favorable Disease Free Survival (DFS) and Overall Survival (OS) for Pediatric Patients (<21 years) with AML in CR1. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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