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Conditioning regimens in allo-SCT for thalassemia major

Abstract

Allogeneic hematopoietic SCT remains the only treatment that can correct the hematological manifestations in patients with thalassemia major. Improving the clinical outcomes of high-risk, heavily transfused patients with liver fibrosis and inadequate iron chelation remains a challenge. Because of the relatively high probability of graft rejection and regimen-related toxicity in many patients receiving SCT for advanced thalassemia major, further development of new treatment regimens is warranted. This review addresses the reported clinical studies in patients with advanced thalassemia major and we have summarized our suggested conditioning approach to improve the outcome after SCT.

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References

  1. Thomas ED, Buckner CD, Sanders JE, Papayannopoulou T, Borgna-Pignatti C, De Stefano P et al. Marrow transplantation for thalassaemia. Lancet 1982; 2: 227–229.

    Article  CAS  Google Scholar 

  2. Lucarelli G, Polchi P, Galimberti M, Izzi T, Delfini C, Manna M et al. Marrow transplantation for thalassaemia following busulphan and cyclophosphamide. Lancet 1985; 1: 1355–1357.

    Article  CAS  Google Scholar 

  3. Bhatia M, Walters MC . Hematopoietic cell transplantation for thalassemia and sickle cell disease: past, present and future. Bone Marrow Transplant 2008; 41: 109–117.

    Article  CAS  Google Scholar 

  4. Lucarelli G, Galimberti M, Polchi P, Angelucci E, Baronciani D, Giardini C et al. Bone marrow transplantation in patients with thalassemia. N Engl J Med 1990; 322: 417–421.

    Article  CAS  Google Scholar 

  5. Lucarelli G, Galimberti M, Polchi P, Angelucci E, Baronciani D, Durazzi SM et al. Bone marrow transplantation in adult thalassemia. Blood 1992; 80: 1603–1607.

    CAS  Google Scholar 

  6. Mathews V, George B, Deotare U, Lakshmi KM, Viswabandya A, Daniel D et al. A new stratification strategy that identifies a subset of class III patients with an adverse prognosis among children with beta thalassemia major undergoing a matched related allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2007; 13: 889–894.

    Article  Google Scholar 

  7. Hongeng S, Pakakasama S, Chuansumrit A, Sirachainan N, Kitpoka P, Udomsubpayakul U et al. Outcomes of transplantation with related- and unrelated-donor stem cells in children with severe thalassemia. Biol Blood Marrow Transplant 2006; 12: 683–687.

    Article  Google Scholar 

  8. Fang JP, Xu LH . Hematopoietic stem cell transplantation for children with thalassemia major in China. Pediatr Blood Cancer 2010; 55: 1062–1065.

    Article  Google Scholar 

  9. Sabloff M, Chandy M, Wang Z, Logan BR, Ghavamzadeh A, Li CK et al. HLA-matched sibling bone marrow transplantation for beta-thalassemia major. Blood 2010; 117: 1745–1750.

    Article  Google Scholar 

  10. Chiesa R, Cappelli B, Crocchiolo R, Frugnoli I, Biral E, Noe A et al. Unpredictability of intravenous busulfan pharmacokinetics in children undergoing hematopoietic stem cell transplantation for advanced beta thalassemia: limited toxicity with a dose-adjustment policy. Biol Blood Marrow Transplant 2010; 16: 622–628.

    Article  CAS  Google Scholar 

  11. Lawson SE, Roberts IA, Amrolia P, Dokal I, Szydlo R, Darbyshire PJ . Bone marrow transplantation for beta-thalassaemia major: the UK experience in two paediatric centres. Br J Haematol 2003; 120: 289–295.

    Article  Google Scholar 

  12. Sodani P, Gaziev D, Polchi P, Erer B, Giardini C, Angelucci E et al. New approach for bone marrow transplantation in patients with class 3 thalassemia aged younger than 17 years. Blood 2004; 104: 1201–1203.

    Article  CAS  Google Scholar 

  13. Lucarelli G, Clift RA, Galimberti M, Polchi P, Angelucci E, Baronciani D et al. Marrow transplantation for patients with thalassemia: results in class 3 patients. Blood 1996; 87: 2082–2088.

    CAS  PubMed  Google Scholar 

  14. Bernardo ME, Zecca M, Piras E, Vacca A, Giorgiani G, Cugno C et al. Treosulfan-based conditioning regimen for allogeneic haematopoietic stem cell transplantation in patients with thalassaemia major. Br J Haematol 2008; 143: 548–551.

    Google Scholar 

  15. Iannone R, Casella JF, Fuchs EJ, Chen AR, Jones RJ, Woolfrey A et al. Results of minimally toxic nonmyeloablative transplantation in patients with sickle cell anemia and beta-thalassemia. Biol Blood Marrow Transplant 2003; 9: 519–528.

    Article  Google Scholar 

  16. Horan JT, Liesveld JL, Fenton P, Blumberg N, Walters MC . Hematopoietic stem cell transplantation for multiply transfused patients with sickle cell disease and thalassemia after low-dose total body irradiation, fludarabine, and rabbit anti-thymocyte globulin. Bone Marrow Transplant 2005; 35: 171–177.

    Article  CAS  Google Scholar 

  17. Gaziev J, Nguyen L, Puozzo C, Mozzi AF, Casella M, Perrone Donnorso M et al. Novel pharmacokinetic behavior of intravenous busulfan in children with thalassemia undergoing hematopoietic stem cell transplantation: a prospective evaluation of pharmacokinetic and pharmacodynamic profile with therapeutic drug monitoring. Blood 2010; 115: 4597–4604.

    Article  CAS  Google Scholar 

  18. Danylesko I, Shimoni A, Nagler A . Treosulfan-based conditioning before hematopoietic SCT: more than a BU look-alike. Bone Marrow Transplant 2012; 47: 5–14.

    Article  CAS  Google Scholar 

  19. Hilger RA, Harstrick A, Eberhardt W, Oberhoff C, Skorzec M, Baumgart J et al. Clinical pharmacokinetics of intravenous treosulfan in patients with advanced solid tumors. Cancer Chemother Pharmacol 1998; 42: 99–104.

    Article  CAS  Google Scholar 

  20. Glowka FK, Karazniewicz-Lada M, Grund G, Wrobel T, Wachowiak J . Pharmacokinetics of high-dose i.v. treosulfan in children undergoing treosulfan-based preparative regimen for allogeneic haematopoietic SCT. Bone Marrow Transplant 2008; 42: S67–S70.

    Article  CAS  Google Scholar 

  21. Scheulen ME, Hilger RA, Oberhoff C, Casper J, Freund M, Josten KM et al. Clinical phase I dose escalation and pharmacokinetic study of high-dose chemotherapy with treosulfan and autologous peripheral blood stem cell transplantation in patients with advanced malignancies. Clin Cancer Res 2000; 6: 4209–4216.

    CAS  Google Scholar 

  22. Cappelli B, Chiesa R, Evangelio C, Biffi A, Roccia T, Frugnoli I et al. Absence of VOD in paediatric thalassaemic HSCT recipients using defibrotide prophylaxis and intravenous Busulphan. Br J Haematol 2009; 147: 554–560.

    Article  CAS  Google Scholar 

  23. Cesaro S, Pillon M, Talenti E, Toffolutti T, Calore E, Tridello G et al. A prospective survey on incidence, risk factors and therapy of hepatic veno-occlusive disease in children after hematopoietic stem cell transplantation. Haematologica 2005; 90: 1396–1404.

    Google Scholar 

  24. de Witte T . The role of iron in patients after bone marrow transplantation. Blood Rev 2008; 22: S22–S28.

    Article  Google Scholar 

  25. Mathews V, George B, Viswabandya A, Abraham A, Ahmed R, Ganapule A et al. Improved clinical outcomes of high risk beta thalassemia major patients undergoing a HLA matched related allogeneic stem cell transplant with a treosulfan based conditioning regimen and peripheral blood stem cell grafts. PLoS One 2013; 8: e61637.

    Article  CAS  Google Scholar 

  26. Srivastava A, Poonkuzhali B, Shaji RV, George B, Mathews V, Chandy M et al. Glutathione S-transferase M1 polymorphism: a risk factor for hepatic venoocclusive disease in bone marrow transplantation. Blood 2004; 104: 1574–1577.

    Article  CAS  Google Scholar 

  27. Chandy M, Balasubramanian P, Ramachandran SV, Mathews V, George B, Dennison D et al. Randomized trial of two different conditioning regimens for bone marrow transplantation in thalassemia—the role of busulfan pharmacokinetics in determining outcome. Bone Marrow Transplant 2005; 36: 839–845.

    Article  CAS  Google Scholar 

  28. Bernardo ME, Piras E, Vacca A, Giorgiani G, Zecca M, Bertaina A et al. Allogeneic hematopoietic stem cell transplantation in thalassemia major: results of a reduced-toxicity conditioning regimen based on the use of treosulfan. Blood 2012; 120: 473–476.

    Article  CAS  Google Scholar 

  29. Choudhary D, Sharma SK, Gupta N, Kharya G, Pavecha P, Handoo A et al. Treosulfan-thiotepa-fludarabine-based conditioning regimen for allogeneic transplantation in patients with thalassemia major: a single-center experience from north India. Biol Blood Marrow Transplant 2012; 19: 492–495.

    Article  Google Scholar 

  30. Rajasekar R, Mathews V, Lakshmi KM, George B, Viswabandya A, Chandy M et al. Cellular immune reconstitution and its impact on clinical outcome in children with beta thalassemia major undergoing a matched related myeloablative allogeneic bone marrow transplant. Biol Blood Marrow Transplant 2009; 15: 597–609.

    Article  CAS  Google Scholar 

  31. Iravani M, Tavakoli E, Babaie MH, Ashouri A, Khatami F, Ghavamzadeh A . Comparison of peripheral blood stem cell transplant with bone marrow transplant in class 3 thalassemic patients. Exp Clin Transplant 2010; 8: 66–73.

    PubMed  Google Scholar 

  32. Ghavamzadeh A, Iravani M, Ashouri A, Mousavi SA, Mahdavi N, Shamshiri A et al. Peripheral blood versus bone marrow as a source of hematopoietic stem cells for allogeneic transplantation in children with class I and II beta thalassemia major. Biol Blood Marrow Transplant 2008; 14: 301–308.

    Article  Google Scholar 

  33. Li C, Wu X, Feng X, He Y, Liu H, Pei F et al. A novel conditioning regimen improves outcomes in beta-thalassemia major patients using unrelated donor peripheral blood stem cell transplantation. Blood 2012; 120: 3875–3881.

    Article  CAS  Google Scholar 

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Correspondence to V Mathews.

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Mathews, V., Savani, B. Conditioning regimens in allo-SCT for thalassemia major. Bone Marrow Transplant 49, 607–610 (2014). https://doi.org/10.1038/bmt.2013.216

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