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Treatment of graft failure with TNI ‐based reconditioning and haploidentical stem cells in paediatric patients
Author(s) -
Teltschik HeikoManuel,
Heinzelmann Frank,
Gruhn Bernd,
Feuchtinger Tobias,
Schlegel Patrick,
Schumm Michael,
Kremens Bernhard,
Müller Ingo,
Ebinger Martin,
Schwarze Carl Philipp,
Ottinger Hellmut,
Zips Daniel,
Handgretinger Rupert,
Lang Peter
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14190
Subject(s) - stem cell , medicine , microbiology and biotechnology , biology
Summary Graft failure is a life‐threatening complication after allogeneic haematopoietic stem cell transplantation ( HSCT ). We report a cohort of 19 consecutive patients (median age: 8·5 years) with acute leukaemias ( n = 14) and non‐malignant diseases ( n = 5) who experienced graft failure after previous HSCT from matched ( n = 3) or haploidentical donors ( n = 16) between 2003 and 2012. After total nodal irradiation ( TNI )‐based reconditioning combined with fludarabine, thiotepa and anti‐T cell serotherapy, all patients received T cell‐depleted peripheral blood stem cell grafts from a second, haploidentical donor. Median time between graft failure and retransplantation was 14 d (range 7–40). Sustained engraftment (median: 10 d, range 9–32) and complete donor chimerism was observed in all evaluable patients. 5 patients additionally received donor lymphocyte infusions. Graft‐versus‐host disease (Gv HD ) grade II and III occurred in 1 patient each (22%); no Gv HD grade IV was observed. 2 patients had transient chronic Gv HD . The regimen was well tolerated with transient interstitial pneumonitis in one patient. Treatment‐related mortality after one year was 11%. Event‐free survival and overall survival 3 years after retransplantation were 63% and 68%. Thus, a TNI ‐based reconditioning regimen followed by transplantation of haploidentical stem cells is an option to rescue patients with graft failure within a short time span and with low toxicity.