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Pediatric Transplants

Low mortality of children undergoing hematopoietic stem cell transplantation from 7 to 8/10 human leukocyte antigen allele-matched unrelated donors with the use of antithymocyte globulin

Bone Marrow Transplantation volume 38, pages 745–750 (2006)Cite this article

Abstract

Human leukocyte antigen (HLA)-matched sibling donor hematopoietic stem cell transplantation (HSCT) is available for only approximately 30% patients needing HSCT. Use of alternative donors is associated with a high incidence and severity of graft-versus-host disease (GVHD). Here we report our experience with GVHD prophylaxis using pre-transplant rabbit antithymocyte globulin (rATG), in addition to post transplant cyclosporin A and methotrexate. Seventy-five children received unmanipulated grafts from 7 to 10/10 HLA allele-matched unrelated donors. Median follow-up was 25 months (range, 6–65 months). Only 2/75 patients (2.5%) developed acute GVHD grades III–IV, and 17/75 (25%) developed extensive chronic GVHD. Overall survival was 79%. It was similar in patients receiving grafts from 7 or 8/10 to 9 or 10/10 allele-matched donors, and similar in patients receiving peripheral blood stem cells and marrow. Six (11%) patients died owing to relapse, and 10 (13%) due to transplant-related complications. The addition of rATG appears to result in a low incidence of severe GVHD and overall mortality.

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Acknowledgements

We thank our collaborators from CPH (Czech Pediatric Hematology Working Group) for referring patients, national registries of donors in Pilsen and Prague, HLA laboratories namely in Institute of Hematology and Blood Transfusion and CLIP (Childhood Leukemia Investigation Prague) in Prague. We thank Jan Storek for editorial help. This work was partly supported by Grant IGA CR NR 8223/3.

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  1. Department of Pediatric Hematology and Oncology, University Hospital Motol, Charles University Prague, Prague, Czech Republic

    P Sedláček, R Formánková, P Keslová, L Šrámková, P Hubáček, L Król & J Starý

  2. Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University Prague, Prague, Czech Republic

    M Kulich

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Correspondence to P Sedláček.

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Sedláček, P., Formánková, R., Keslová, P. et al. Low mortality of children undergoing hematopoietic stem cell transplantation from 7 to 8/10 human leukocyte antigen allele-matched unrelated donors with the use of antithymocyte globulin. Bone Marrow Transplant 38, 745–750 (2006). https://doi.org/10.1038/sj.bmt.1705524

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