title: Outcomes of hematopoietic stem cell transplantation in primary immunodeficiency: a report from the Australian and New Zealand Children's Haematology Oncology Group and the Australasian Bone Marrow Transplant Recipient Registry.
abstract: We performed a retrospective analysis on the outcomes of 135 hematopoietic stem cell transplantations (HSCTs) for primary immunodeficiency disorders in Australian and New Zealand Children's Haematology Oncology Group transplantation centers between 1992 and 2008. The most common indications for HSCT were severe combined immunodeficiency, Wiskott-Aldrich syndrome, and chronic granulomatous disease. Five-year overall survival (OS) was 72% for the entire cohort. Disease-specific 5-year OS was 70% for severe combined immunodeficiency, 81% for Wiskott-Aldrich syndrome, and 69% for chronic granulomatous disease. Transplantation-related mortality (TRM) was 10% at day +100. TRM and OS were equivalent in recipients of related and unrelated donor transplants. Source of stem cells had no impact on TRM or OS with outcomes following unrelated umbilical cord blood similar to unrelated bone marrow. The presence of interstitial pneumonitis, active cytomegalovirus infection, or veno-occlusive disease were all independent variables that significantly decreased OS. This large series supports the use of HSCT as curative therapy for a range of primary immunodeficiency disorders, demonstrating excellent survival after both related and unrelated donor transplantation.
authors.affiliation: Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Mitchell
authors.forename: Ian
authors.initials: I
authors.lastname: Nivison-Smith
authors.forename: Antoinette
authors.initials: A
authors.lastname: Anazodo
authors.forename: Karin
authors.initials: K
authors.lastname: Tiedemann
authors.forename: Peter
authors.initials: P
authors.lastname: Shaw
authors.forename: Lochie
authors.initials: L
authors.lastname: Teague
authors.forename: Chris
authors.initials: C
authors.lastname: Fraser
authors.forename: Tina
authors.initials: T
authors.lastname: Carter
authors.forename: Heather
authors.initials: H
authors.lastname: Tapp
authors.forename: Frank
authors.initials: F
authors.lastname: Alvaro
authors.forename: Tracey A
authors.initials: TA
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D001315:Australia; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D006086:Graft vs Host Disease / Q000517:prevention & control; D006105:Granulomatous Disease, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D009520:New Zealand; D012042:Registries; D012189:Retrospective Studies; D016511:Severe Combined Immunodeficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014923:Wiskott-Aldrich Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*