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Treatment of graft failure with TNI-based reconditioning and haploidentical stem cells in paediatric patients.

Abstract：

:Graft failure is a life-threatening complication after allogeneic haematopoietic stem cell transplantation (HSCT). We report a cohort of 19 consecutive patients (median age: 8·5 years) with acute leukaemias (n = 14) and non-malignant diseases (n = 5) who experienced graft failure after previous HSCT from matched (n = 3) or haploidentical donors (n = 16) between 2003 and 2012. After total nodal irradiation (TNI)-based reconditioning combined with fludarabine, thiotepa and anti-T cell serotherapy, all patients received T cell-depleted peripheral blood stem cell grafts from a second, haploidentical donor. Median time between graft failure and retransplantation was 14 d (range 7-40). Sustained engraftment (median: 10 d, range 9-32) and complete donor chimerism was observed in all evaluable patients. 5 patients additionally received donor lymphocyte infusions. Graft-versus-host disease (GvHD) grade II and III occurred in 1 patient each (22%); no GvHD grade IV was observed. 2 patients had transient chronic GvHD. The regimen was well tolerated with transient interstitial pneumonitis in one patient. Treatment-related mortality after one year was 11%. Event-free survival and overall survival 3 years after retransplantation were 63% and 68%. Thus, a TNI-based reconditioning regimen followed by transplantation of haploidentical stem cells is an option to rescue patients with graft failure within a short time span and with low toxicity.

journal_name

Br J Haematol

journal_title

British journal of haematology

authors

Teltschik HM,Heinzelmann F,Gruhn B,Feuchtinger T,Schlegel P,Schumm M,Kremens B,Müller I,Ebinger M,Schwarze CP,Ottinger H,Zips D,Handgretinger R,Lang P

doi

10.1111/bjh.14190

subject

Has Abstract

pub_date

2016-10-01 00:00:00

pages

115-22

issue

1

eissn

0007-1048

issn

1365-2141

journal_volume

175

pub_type

杂志文章

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