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Haploidentical stem cell transplantation for children with high‐risk leukemia
Author(s) -
Palma Julia,
Salas Lucia,
Carrión Flavio,
Sotomayor Cristián,
Catalán Paula,
Paris Claudia,
Turner Victoria,
Jorquera Hugo,
Handgretinger Rupert,
Rivera Gastón K
Publication year - 2012
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24022
Subject(s) - medicine , hematopoietic stem cell transplantation , transplantation , population , leukemia , regimen , complication , pediatrics , surgery , environmental health
Background The Chilean population is ethnically diverse, and more than 50% of children referred for hematopoietic stem cell transplantation (HSCT) lack a suitable donor. Procedure To expand the donor pool, we assessed the feasibility, tolerance, and efficacy of using a haploidentical (HI) donor and a reduced‐intensity conditioning regimen for high‐risk pediatric leukemia. This study was facilitated by technology transfer from St. Jude Children's Research Hospital over the 2 preceding years. Results Between March 2006 and April 2009, 10 patients (median age, 9.8 years) received T cell‐depleted grafts at Calvo Mackenna Hospital in Santiago. Median cell doses were CD34+: 7.45 × 10 6 /kg (range, 4.00–20.20 × 10 6 /kg); CD3+: 0.88 × 10 5 /kg (0.11–1.35 × 10 5 /kg); and CD56+: 71.30 × 10 6 /kg (31.50–131.80 × 10 6 /kg). Nine patients experienced complete engraftment; six of the nine remain alive and clinically well 13–50 months post‐HSCT. Three patients died after bone marrow relapse, while only one died of transplant‐related causes. Virus reactivation was the main post‐transplant complication: 5/10 had positive CMV PCR but none had CMV disease. One patient developed acute GvHD > grade II and only one had chronic GvHD. Conclusions HI‐HSCT is feasible in our setting, offers a rational treatment option, and expands the donor pool significantly for children with high‐risk leukemia in a developing country. This information is especially relevant to other ethnically diverse populations that are poorly represented in international donor registries. Pediatr Blood Cancer 2012; 59: 895–901. © 2012 Wiley Periodicals, Inc.