Umbilical cord blood transplant from unrelated HLA-mismatched donors in children with high risk leukemia
| Autor: | Giuseppe Cimino, A. P. Iori, Atelda Romano, L. De Felice, Luca Laurenti, Andrea Mengarelli, I. Del Giudice, Anna Maria Testi, F. Boecklin, Giuseppe Gentile, Cesare Guglielmi, P. Perrone, Loredana Elia, Maria Screnci, Franco Mandelli, D. Carmini, M. C. Rapanotti, William Arcese, Maria Luisa Moleti |
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| Předmět: |
Male
medicine.medical_specialty Adolescent Graft vs Host Disease Tissue Banks Umbilical cord Gastroenterology Fetal Tissue Transplantation HLA Antigens Risk Factors Immunopathology Internal medicine Medicine Humans Preschool Child Etoposide children cord blood leukemia transplantation Transplantation Transplantation Chimera Leukemia business.industry Histocompatibility Testing Hematology medicine.disease Fetal Blood Tissue Donors Surgery Haematopoiesis surgical procedures operative medicine.anatomical_structure Treatment Outcome Cord blood Child Preschool Female business Complication Settore MED/15 - Malattie del Sangue medicine.drug |
| Zdroj: | Scopus-Elsevier |
| Popis: | In the last 3 years, 14 children with high-risk leukemia (11 ALL, 2 AML and 1 CML) underwent cord blood transplantation from unrelated HLA-mismatched donors at a median of 99 days from the start of search. Eight patients were transplanted in second CR, one in accelerated phase, three at relapse and two patients in first CR. Conditioning regimen (fractionated TBI, etoposide, CY and anti-lymphocyte serum) and prophylaxis of GVHD (CsA and 6-methylprednisolone) were identical for all patients. Neutrophils >0.5x10(9)/l were reached at a median of 33 days from transplant, but in four cases we observed an autologous hematopoietic reconstitution (three spontaneous, one after autologous BM rescue). Acute and chronic GVHD were observed in 10/14 and 3/8 evaluable cases, respectively. Three patients died of transplant-related toxicity and three patients relapsed. The probabilities of event-free, disease-free and overall survival were 50, 53 and 64%, respectively. Cord blood transplant from HLA-mismatched unrelated donor is a valid option for the treatment of children with high-risk leukemia. With our eligibility criteria, conditioning regimen and prophylaxis of graft-versus-host disease, the main obstacles to successful transplant were represented by graft failure and fatal acute GVHD. |
| Databáze: | OpenAIRE |
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