Haematopoietic stem cell transplantation in haemophagocytic lymphohistiocytosis.
Haemophagocytic lymphohistiocytosis (HLH) poses major therapeutic challenges, and the primary inherited form, familial haemophagocytic lymphohistiocytosis (FHL), is usually fatal. We evaluated, including Cox regression analysis, survival in 86 children (29 familial) that received HLH-94-therapy (etoposide, dexamethasone, ciclosporin) followed by allogeneic stem cell transplantation (SCT) between 1995 and 2000. The overall estimated 3-year-survival post-SCT was 64% [confidence interval (CI) = +/-10%] (n = 86); 71 +/- 18% in those patients with a matched related donor (MRD, n = 24), 70 +/- 16% with a matched unrelated donor (MUD, n = 33), 50 +/- 24% with a family haploidentical donor (haploidentical, n = 16), and 54 +/- 27% with a mismatched unrelated donor (MMUD, n = 13). After adjustment for potential confounding factors, estimated odds ratios (OR) for mortality were 1.93 (CI =0.61-6.19) for MUD, 3.31 (1.02-10.76) for haploidentical, and 3.01 (0.91-9.97) for MMUD, compared with MRD. In children with active disease after 2-months of therapy (n = 43) the OR was 2.75 (1.26-5.99), compared with inactive disease (n = 43). In children with active disease at SCT (n = 37), the OR was 1.80 (0.80-4.06) compared with inactive disease (n = 49), after adjustment for disease activity at 2-months. Mortality was predominantly transplant-related. Most HLH patients survived SCT using MRD or MUD, and survival with partially mismatched donors was also acceptable. Patients that responded well to initial pretransplant-induction therapy fared best, but some persisting HLH activity should not automatically preclude performing SCT.
Horne
Annacarin
A
Childhood Cancer Research Unit, Institution for Woman and Child Health, Karolinska Institutet, Department of Paediatric Haematology and Oncology, Karolinska Hospital, Stockholm, Sweden.
Janka
Gritta
G
Maarten Egeler
R
R
Gadner
Helmut
H
Imashuku
Shinsaku
S
Ladisch
Stephan
S
Locatelli
Franco
F
Montgomery
Scott M
SM
Webb
David
D
Winiarski
Jacek
J
Filipovich
Alexandra H
AH
Henter
Jan-Inge
JI
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D015616:Histiocytosis, Non-Langerhans-Cell / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D016017:Odds Ratio; D012044:Regression Analysis; D012086:Reoperation; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D005047:Etoposide; D003907:Dexamethasone; D016572:Cyclosporine; D008727:Methotrexate