Outcomes of Unmanipulated Haploidentical Transplantation Using Post-Transplant Cyclophosphamide (PT-Cy) in Pediatric Patients With Acute Lymphoblastic Leukemia
| Autor: | Selim Corbacioglu, Arnaud Dalissier, Annalisa Ruggeri, Akif Yesilipek, Mikael Sundin, José M. Fernández Navarro, Franco Locatelli, Rose-Marie Hamladji, Vanderson Rocha, Maura Faraci, Concepción Herrera, O.V. Paina, Jose Rifón, E V Skorobogatova, Jacques-Emmanuel Galimard, Abdelghani Tbakhi, Franca Fagioli, Amal Al-Seraihy |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Transplantation Conditioning Haploidentical transplantation Disease Acute lymphoblastic leukemia Gastroenterology Internal medicine medicine Immunology and Allergy Humans Cumulative incidence Post-transplantation cyclophosphamide Child Childhood Acute Lymphoblastic Leukemia Cyclophosphamide Retrospective Studies Transplantation business.industry Hazard ratio Cell Biology Hematology Precursor Cell Lymphoblastic Leukemia-Lymphoma Childhood surgical procedures operative medicine.anatomical_structure Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA Transplantation Haploidentical Molecular Medicine Bone marrow Stem cell business |
| Popis: | HLA-haploidentical transplantation (haplo-HCT) using post-transplantation-cyclophosphamide (PT-Cy) is a feasible procedure in children with malignancies. However, large studies on Haplo-HCT with PT-Cy for childhood acute lymphoblastic leukemia (ALL) are lacking. We analyzed haplo-HCT outcomes in 180 children with ALL. Median age was 9 years, and median follow-up was 2.7 years. Disease status was CR1 for 24%, CR2 for 45%, CR+3 for 12%, and active disease for 19%. All patients received PT-Cy day +3 and +4. Bone marrow (BM) was the stem cell source in 115 patients (64%). Cumulative incidence of 42-day engraftment was 88.9%. Cumulative incidence of day-100 acute graft-versus-host disease (GVHD) grade II-IV was 28%, and 2-year chronic GVHD was 21.9%. At 2 years, cumulative incidence of nonrelapse mortality (NRM) was 19.6%. Cumulative incidence was 41.9% for relapse and 25% for patients in CR1. Estimated 2-year leukemia free survival was 65%, 44%, and 18.8% for patients transplanted in CR1, CR2, CR3+ and 3% at 1 year for active disease. In multivariable analysis for patients in CR1 and CR2, disease status (CR2 [hazard ratio {HR} = 2.19; P = .04]), age at HCT older than 13 (HR = 2.07; P = .03) and use of peripheral blood stem cell (PBSC) (HR = 1.98; P = .04) were independent factors associated with decreased overall survival. Use of PBSC was also associated with higher NRM (HR = 3.13; P = .04). Haplo-HCT with PT-Cy is an option for children with ALL, namely those transplanted in CR1 and CR2. Age and disease status remain the most important factors for outcomes. BM cells as a graft source is associated with improved survival. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|