1. ¹Department of Pediatric Hematology-Oncology, Dana-Farber Cancer Institute and Children's Hospital, Boston, MA, USA
2. ²Harvard Medical School, Boston, MA, USA
3. ³Department of Pediatrics and 'Angelo Novicelli' Institute for Molecular Medicine, University of Brescia, Brescia, Italy
4. ⁴Terzo Servizio Analisi Chimico-Cliniche, Spedali Civili, Brescia, Italy

Correspondence: Dr LD Notarangelo, Department of Pediatrics and 'Angelo Novicelli' Institute for Molecular Medicine, University of Brescia, Spedali Civili, 25123 Brescia, Italy. E-mail: notarang@med.unibs.it

Received 17 July 2006; Revised 1 September 2006; Accepted 4 September 2006; Published online 2 October 2006.

Abstract

The treatment of Wiskott–Aldrich syndrome (WAS), a once uniformly fatal disorder, has evolved considerably as the use of hematopoietic stem cell transplant has become more widespread. For the majority of patients who lack an human leukocyte antigen-identical sibling, closely matched unrelated donor bone marrow transplant (MUD BMT) at an early age is an excellent option that nevertheless is not uniformly chosen. We retrospectively analyzed our experience with transplantation in 23 patients with WAS from 1990 to 2005 at the University of Brescia, Italy, of whom 16 received MUD BMT. Myeloablative chemotherapy was well tolerated with median neutrophil engraftment at day 18, and no cases of grade III or IV graft-vs-host disease. Overall survival was very good with 78.2% (18/23) of the whole cohort and 81.2% (13/16) of MUD BMT recipients surviving. Among 18 survivors, full donor engraftment was detected in 12 patients, and stable mixed chimerism in all blood lineages in four patients. Deaths were limited to patients who had received mismatched related BMT or who had severe clinical symptomatology at the time of transplantation, further emphasizing the safety and efficacy of MUD BMT when performed early in the clinical course of WAS.