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Conditioning Regimens

Reduced-intensity conditioning followed by allogeneic transplantation in pediatric malignancies: a report from the Société Française des Cancers de l’Enfant and the Société Française de Greffe de Moelle et de Thérapie Cellulaire

Bone Marrow Transplantation volume 48, pages 1401–1408 (2013)Cite this article

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Abstract

We report French prospective experience with reduced-intensity conditioning–allo-SCT in 46 patients (median age: 15.5 years, 4.8–20.2) presenting high-risk AL (n=11), Hodgkin’s lymphoma (n=15) or solid tumors (n=20). Graft sources were BM (n=21), PBSC (n=20) and cord blood (CB; n=5) from related (n=20) or unrelated (n=26) donors. For CB grafts, only one patient out of five achieved sustained engraftment. For PBSC/BM grafts, engraftment rate was 95%, hematopoietic recovery times were not significantly different between BM, PBSC, sibling or unrelated grafts, day+100. Full donor chimerism was achieved in 94% of patients, and incidences of primary acute GVHD and chronic GVHD were 49% and 14%, respectively. Underlying disease was fatal in 39% of patients. TRM was 6.9%. Three-year OS was 49.15%. OS and EFS were not significantly different between patients transplanted with different grafts and with or without primary GVHD. Patients with solid tumor or measurable disease at transplant had poorer outcomes. Three-year EFS: 33.3% for ALL, 75.0% for AML, 51.8% for Hodgkin’s lymphoma, 28.6% for neuroblastoma and 22.2% for sarcoma patients. This multicentre study concluded that Bu/fludarabine/anti-thymocyte globulin conditioning with PB or BM, related or unrelated grafts in patients with various malignancies at high-risk for transplantation toxicity results in high engraftment rates, low TRM and acceptable survival.

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Acknowledgements

This work was supported by ‘La Ligue Contre le Cancer du Puy-de-Dôme’.

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Authors and Affiliations

  1. CHU Clermont-Ferrand, Centre Régional de Cancérologie et Thérapie Cellulaire Pédiatrique, Clermont-Ferrand, France

    C Paillard, E Rochette, E Dore, F Isfan, E Merlin, P Halle, N Rabiau, J Kanold & F Deméocq

  2. INSERM, CIC501, Clermont-Ferrand, France

    E Rochette, F Isfan, E Merlin, P Halle, N Rabiau, J Kanold & F Deméocq

  3. Service de Pédiatrie I, Hôpital Haute Pierre, CHU, Strasbourg, France

    P Lutz

  4. Institut d’Hématologie Oncologie Pédiatrique, Lyon, France

    Y Bertrand

  5. Unité de Transplantation Médullaire, Hôpital de la Timone, Marseille, France

    G Michel

  6. Service de Médecine Infantile II, Hôpital de Brabois, CHU, Nancy, France

    P Bordigoni

  7. Hôpital Robert Debré, Service d'Hémato-Immunologie, Université Paris 7—Denis Diderot, Paris, France

    J H Dalle

  8. Hématologie Clinique, CHU, Besançon, France

    P Rohrlich

  9. Hôpital C Nicolle, CHU, Rouen, France

    J P Vannier

  10. Service de Pédiatrie, CHU, Bordeaux, France

    Y Perel

  11. Service de Pédiatrie, CHU, Grenoble, France

    D Plantaz

  12. Service de Pédiatrie, Hôpital Armand Trousseau, Paris, France

    G Leverger

  13. Unité de Transplantation Médullaire, CHU, Nice, France

    A Sirvent

  14. Délégation Recherche Clinique & Innovation, CHU, Clermont-Ferrand, France

    B Pereira

  15. Université d’Auvergne, Clermont-Ferrand, France

    J Kanold & F Deméocq

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  1. C Paillard
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  2. E Rochette
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  3. P Lutz
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  16. E Merlin
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  18. P Halle
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Correspondence to F Deméocq.

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Paillard, C., Rochette, E., Lutz, P. et al. Reduced-intensity conditioning followed by allogeneic transplantation in pediatric malignancies: a report from the Société Française des Cancers de l’Enfant and the Société Française de Greffe de Moelle et de Thérapie Cellulaire. Bone Marrow Transplant 48, 1401–1408 (2013). https://doi.org/10.1038/bmt.2013.82

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