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Graft-Versus-Host Disease

Haploidentical hematopoietic stem cell transplantation in children with high-risk hematologic malignancies: outcomes with two different strategies for GvHD prevention. Ex vivo T-cell depletion and post-transplant cyclophosphamide: 10 years of experience at a single center

Bone Marrow Transplantation volume 51, pages 1354–1360 (2016)Cite this article

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Abstract

Forty patients with high-risk hematologic malignancies, median age 9 years, underwent haploidentical-HSCT from April 2005 to April 2015. Seventeen patients were transplanted with CD3-depleted PBSCs by negative selection (TCD group) following a reduced-intensity conditioning regimen (RIC), and 23 patients received T-cell-replete PBSCs followed by post-transplantation cyclophosphamide (PT-Cy group) after myeloablative conditioning (n=16) or RIC (n=7). Outcomes are reported for the TCD and PT-Cy recipients, respectively. Engraftment was achieved in 88% versus 100%. Median time to neutrophils>500/μL was 10 days versus 15 days. Platelets>20 000/μL occurred at a median of 16 days versus 20 days, respectively. Transplant-related mortality (TRM) was 24% versus 26% at 1 year. The cumulative incidence (CI) of grade III−IV acute GvHD was 7% versus 5%, and chronic GvHD 9% versus 53% (P=0.029). Relapse at 2 years was 31% versus 24%. Actuarial overall survival rates at 2 years were 47% versus 48%. Causes of death were infections (n=3), sinusoidal obstructive syndrome (n=4), acute GvHD (n=2) and relapse (n=9). These results indicate that haploidentical-HSCT is feasible in Uruguay. The TRM rate is of concern and should be the focus of continuing attention. Chronic GvHD risk was higher in the PT-Cy approach, so modifications are justified.

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Authors and Affiliations

  1. Pediatric Hemato-Oncology Department, Centro Hospitalario Pereira Rosell, Montevideo, Uruguay

    G Dufort, L Castillo, M Castiglioni, P Carolina, I Andrea, E Simon, S Zuccolo, M Schelotto, F Morosini, I Pereira, P Amarillo & A Dabezies

  2. Transfusion Medicine Department, Centro Hospitalario Pereira Rosell, Montevideo, Uruguay

    S Pisano, A Tiscornia, R Mezzano, F Lemos & B Boggia

  3. Statistics Department, Centro Hospitalario Pereira Rosell, Montevideo, Uruguay

    A Silveira

  4. Radiotherapy Department, Centro Hospitalario Pereira Rosell, Montevideo, Uruguay

    L Guerrero, V Ferreira & A Quarnetti

  5. Transfusion Medicine Department, Asociación Española, Montevideo, Uruguay

    J Decaro

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  1. G Dufort
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Correspondence to G Dufort.

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Dufort, G., Castillo, L., Pisano, S. et al. Haploidentical hematopoietic stem cell transplantation in children with high-risk hematologic malignancies: outcomes with two different strategies for GvHD prevention. Ex vivo T-cell depletion and post-transplant cyclophosphamide: 10 years of experience at a single center. Bone Marrow Transplant 51, 1354–1360 (2016). https://doi.org/10.1038/bmt.2016.161

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