title: Reduced-intensity conditioning followed by allogeneic transplantation in pediatric malignancies: a report from the Société Française des Cancers de l'Enfant and the Société Française de Greffe de Moelle et de Thérapie Cellulaire.
abstract: We report French prospective experience with reduced-intensity conditioning-allo-SCT in 46 patients (median age: 15.5 years, 4.8-20.2) presenting high-risk AL (n=11), Hodgkin's lymphoma (n=15) or solid tumors (n=20). Graft sources were BM (n=21), PBSC (n=20) and cord blood (CB; n=5) from related (n=20) or unrelated (n=26) donors. For CB grafts, only one patient out of five achieved sustained engraftment. For PBSC/BM grafts, engraftment rate was 95%, hematopoietic recovery times were not significantly different between BM, PBSC, sibling or unrelated grafts, day+100. Full donor chimerism was achieved in 94% of patients, and incidences of primary acute GVHD and chronic GVHD were 49% and 14%, respectively. Underlying disease was fatal in 39% of patients. TRM was 6.9%. Three-year OS was 49.15%. OS and EFS were not significantly different between patients transplanted with different grafts and with or without primary GVHD. Patients with solid tumor or measurable disease at transplant had poorer outcomes. Three-year EFS: 33.3% for ALL, 75.0% for AML, 51.8% for Hodgkin's lymphoma, 28.6% for neuroblastoma and 22.2% for sarcoma patients. This multicentre study concluded that Bu/fludarabine/anti-thymocyte globulin conditioning with PB or BM, related or unrelated grafts in patients with various malignancies at high-risk for transplantation toxicity results in high engraftment rates, low TRM and acceptable survival.
authors.affiliation: CHU Clermont-Ferrand, Centre Régional de Cancérologie et Thérapie Cellulaire Pédiatrique, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Paillard
authors.forename: E
authors.initials: E
authors.lastname: Rochette
authors.forename: P
authors.initials: P
authors.lastname: Lutz
authors.forename: Y
authors.initials: Y
authors.lastname: Bertrand
authors.forename: G
authors.initials: G
authors.lastname: Michel
authors.forename: P
authors.initials: P
authors.lastname: Bordigoni
authors.forename: J H
authors.initials: JH
authors.lastname: Dalle
authors.forename: P
authors.initials: P
authors.lastname: Rohrlich
authors.forename: J P
authors.initials: JP
authors.lastname: Vannier
authors.forename: Y
authors.initials: Y
authors.lastname: Perel
authors.forename: D
authors.initials: D
authors.lastname: Plantaz
authors.forename: G
authors.initials: G
authors.lastname: Leverger
authors.forename: A
authors.initials: A
authors.lastname: Sirvent
authors.forename: E
authors.initials: E
authors.lastname: Dore
authors.forename: F
authors.initials: F
authors.lastname: Isfan
authors.forename: E
authors.initials: E
authors.lastname: Merlin
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.forename: P
authors.initials: P
authors.lastname: Halle
authors.forename: N
authors.initials: N
authors.lastname: Rabiau
authors.forename: J
authors.initials: J
authors.lastname: Kanold
authors.forename: F
authors.initials: F
authors.lastname: Deméocq
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult