Allogeneic stem cell transplantation in children with leukemia using human leukocyte antigen-mismatched unrelated donors.
Allogeneic HSCT is a curative treatment, when chemotherapy fails, for certain malignant diseases. In Europe, only 15% of the indicated children have an HLA-matched sibling available; in 65-70% of others, HLA allele-matched (9-10/10) UDs can be identified. For the rest, it is necessary to identify other alternative donors (HLA-mismatched family or unrelated cord blood). We present our data of HSCT using HLA partially allele-mismatched (7-8/10) UDs in 24 children with leukemia. Uniform GvHD prophylaxis was used (rATG, CsA and MTX). Acute GvHD grade II was diagnosed in 70.8% of the patients and grade III-IV in 12.5%. Overall incidence of chronic GvHD was 38.7% (extensive in 30%). The probability of EFS was 60.3% (95% CI 35.5-78.1) and OS was 74.9 (95% CI 49.1-88.9). No difference in survival between PBSC and BM recipients was observed. TRM at day + 100 was 4%, and overall was 12.5%. We conclude that used combination of drugs for GvHD prophylaxis is efficient even for patients transplanted with grafts from a HLA-mismatched UDs. It enables stable engraftment, good control of GvHD, full reconstitution of immunity, and is not connected with unacceptable transplant-related mortality.
Sedlacek
Petr
P
Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University, Prague, Czech Republic. petr.sedlacek@lfmotol.cuni.cz
Formankova
Renata
R
Mejstrikova
Ester
E
Keslova
Petra
P
Hubacek
Petr
P
Dobrovolna
Marie
M
Vrana
Milena
M
Kupkova
Libuse
L
Pittrova
Helena
H
Stary
Jan
J
D000293:Adolescent; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000601:surgery*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery; D008297:Male; D033581:Stem Cell Transplantation; D014019:Tissue Donors; D014181:Transplantation Immunology
D000961:Antilymphocyte Serum