Pediatric bone marrow transplantation for leukemia and aplastic anemia. Report of 222 cases transplanted in a single center.
We report a single center experience of 222 patients (pts) less than 18 years old transplanted from 1973 to 1987. The median age was 11 years (1-18). The donor was a monozygotic twin (9 pts), an HLA-id sibling (193 pts), an HLA-id, parent (9 pts), a mismatched related donor (9 pts) and a matched unrelated donor (1 pt). Ninety-six pts were transplanted for SAA. Conditioning varied with time but the majority (59 pts) received CY 150 mg/kg and 6 Gy TAI. The long term actuarial survival is 66% with a median follow-up of 3 years. The group who received CY 200 mg/kg and MTX had a 33% long term survival (LTS). GVH was the main complication with 40% acute and 37% chronic GVHD. Chronic GVHD tended to improve with time after 2 to 4 years of evolution. Ninety pts were transplanted for leukemia (35 AML, 45 ALL and 11 CGL), 20 pts were in relapse. Pts in CR had a LTS of 40%, in pts in relapse, it was 12%. The main causes of death were: interstitial pneumonitis (30%), relapse (27%), GVH (15%). Thirty-five pts were transplanted for constitutional disease: Fanconi anemia (FA) (26 pts), Dyskeratosis congenita (2 pts), Blackfan-Diamond erythroblastopenia (2 pts), Glanzmann thrombasthenia (1 pt), osteopetrosis (1 pt) and Gaucher's disease (1 pt). In FA, the LTS is 70% with a CY 20 mg/kg, 5 Gy TAI regimen. In all disease categories, we did not find any influence of donor's sex on GVH and survival.(ABSTRACT TRUNCATED AT 250 WORDS)
Gluckman
E
E
Unité Fonctionnelle de Greffe de Moelle, Hôpital Saint-Louis, Paris, France.
Esperou
H
H
Devergie
A
A
Traineau
R
R
Leverger
G
G
Schaison
G
G
D000293:Adolescent; D000741:Anemia, Aplastic / Q000601:surgery*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005199:Fanconi Anemia / Q000601:surgery; D005500:Follow-Up Studies; D030342:Genetic Diseases, Inborn / Q000601:surgery; D006086:Graft vs Host Disease; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000601:surgery*; D011183:Postoperative Complications; D011658:Pulmonary Fibrosis / Q000209:etiology; D012008:Recurrence