Abstract:
:T cell-depleted haploidentical hematopoietic stem cell transplantation (haploHSCT) is an option to treat children with very high-risk acute lymphoblastic leukemia (ALL) lacking an HLA-identical donor. We analyzed 127 children with ALL who underwent haploHSCT in first (n = 22), second (n = 48), or third (n = 32), complete remission or in relapse (n = 25). The 5-year leukemia-free survival (LFS) was 30%, 34%, 22%, and 0%, respectively. A risk-factor analysis was performed for patients who underwent transplantation in remission (n = 102). Five-year nonrelapse mortality (NRM), relapse incidence (RI), and LFS were 37%, 36%, and 27%, respectively. A trend of improved LFS rate and decreased RI was observed for children given a graft with higher number of CD34(+) cells (adjusted P = .09 and P = .07, respectively). In a multivariate analysis, haploHSCT performed in larger centers (performing > or = 231 allotransplantations in the studied period) was associated with improved LFS rate and decreased RI (adjusted P = .01 and P = .04, respectively), adjusting for different patient-, disease-, and transplant-related factors such as number of previous autotransplantations, cytomegalovirus serology status, type of T-cell depletion, and use of total body irradiation and antithymocyte globulin. In conclusion, higher CD34(+) cell dose and better patient selection may improve outcomes of children with ALL who undergo a haploHSCT. Transplant centers initiating programs on haploHSCT for children may collaborate with more experienced centers.
journal_name
Bloodjournal_title
Bloodauthors
Klingebiel T,Cornish J,Labopin M,Locatelli F,Darbyshire P,Handgretinger R,Balduzzi A,Owoc-Lempach J,Fagioli F,Or R,Peters C,Aversa F,Polge E,Dini G,Rocha V,Pediatric Diseases and Acute Leukemia Working Parties of the Europedoi
10.1182/blood-2009-03-207001subject
Has Abstractpub_date
2010-04-29 00:00:00pages
3437-46issue
17eissn
0006-4971issn
1528-0020pii
blood-2009-03-207001journal_volume
115pub_type
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