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Pediatric Transplants

Unrelated donor marrow transplantation in children: transplant policy and outcome in Leiden Paediatrics SCT-Centre

Bone Marrow Transplantation volume 45, pages 87–95 (2010)Cite this article

Abstract

The transplant policy for unrelated donor (UD) BMT at Leiden Paediatrics' SCT-Centre consisted of the use of (1) fully HLA-matched donors or, if not available, HLA-class I matched and/or cytotoxic T-lymphocyte precursor (CTLp)-negative donors and (2) protective isolation of the recipient and antimicrobial suppression of his/her gut microflora to prevent infections and acute GVHD. Engraftment, GVHD, relapse in the case of malignancy and survival were studied retrospectively in 126 evaluable children, transplanted between 1988 and 2005. In addition to the effect of HLA-matching, that of other transplant-relevant variables on the outcome was also studied. Actuarial OS was 65% and the EFS was 59%, 13% graft failures occurred and 7.5% ⩾grade II acute GVHD. HLA-class II mismatches combined with HLA-class I matches resulted in a superior OS of 92%, as did a negative vs positive CTLp test, that is, 65 vs 33%. Analysis of other variables showed a poorer OS in patients ⩾10 yrs vs <10 yrs, that is, 54 vs 73%, and in male recipients of a female donor graft, that is, 53 vs 69% for other combinations. UD-BMT can be optimized by permitting HLA-class I-matched and/or CTLp-negative donors, and probably by choosing male donors for male recipients.

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Acknowledgements

We thank the medical, nursing and ancillary staff of the IHOBA unit for their care and management of children undergoing BMT. Prof. Dr Hans C van Houwelingen, Department of Medical Statistics and Bioinformatics and Prof. Dr Jon J van Rood, Europdonor Foundation, are gratefully acknowledged for their expert advice.

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  1. M H van Weel-Sipman: Deceased.

Authors and Affiliations

  1. Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands

    J M Vossen, A E Donker, M H van Weel-Sipman, R G M Bredius, J D J Bakker & R M Egeler

  2. Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands

    M B A Heemskerk & M Oudshoorn

  3. Europdonor Foundation, Leiden, The Netherlands

    M B A Heemskerk, J L W T j Lie & M Oudshoorn

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  1. J M Vossen
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Vossen, J., Donker, A., Heemskerk, M. et al. Unrelated donor marrow transplantation in children: transplant policy and outcome in Leiden Paediatrics SCT-Centre. Bone Marrow Transplant 45, 87–95 (2010). https://doi.org/10.1038/bmt.2009.104

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