Haploidentical versus Cord Blood Transplantation in Pediatric AML. A Retrospective Outcome Analysis on Behalf of the Pediatric Subcommittee of GETH (Grupo Espanol de Trasplante Hematopoyetico)

被引:1
作者
Sisinni, Luisa [1 ]
Monserrate, Gerardo Xavier Aguilar [2 ]
Hurtado, Jose Maria Perez [3 ]
Panesso, Melissa [4 ]
Molina, Blanca [5 ]
Fuentes, Carolina [6 ]
Fuster, Jose Luis [7 ]
Verdu-Amoros, Jaime [8 ,9 ]
Regueiro, Alexandra [10 ]
Palomo, Pilar [11 ]
Belendez, Cristina [12 ]
Pascual, Antonia [13 ]
Badell, Isabel [14 ]
Mozo, Yasmina [1 ]
Bueno, David [1 ]
Perez-Martinez, Antonio [1 ]
Fernandez, Jose Maria [6 ]
Vicent, Marta Gonzalez [5 ]
de Heredia, Cristina Diaz [4 ]
机构
[1] Hosp Univ La Paz, Hematol & Oncol Pediat, Madrid, Spain
[2] Hosp Clin Univ Valladolid, Serv Hematol, Valladolid, Spain
[3] Hosp Virgen del Rocio, UGC Hematol, Unidad Hematol Pediat, Seville, Spain
[4] Hosp Univ Vall dHebron, Serv Oncol & Hematol Pediat, Unidad HSCT, Barcelona, Spain
[5] Hosp Nino Jesus, Hematol Oncol Pediat, Madrid, Spain
[6] Hosp La Fe, Hematol Pediat, Valencia, Spain
[7] Hosp Clin Univ Virgen Arrixaca, Secc Oncohematol Peditr, Inst Murciano Invest Biosanitaria IMIB, Murcia, Spain
[8] Hosp Clin Univ, Hematol Pediat, Valencia, Spain
[9] INCLIVA Biomed Res Inst, Valencia, Spain
[10] Hosp Santiago de Compostela, Hematol Pediat, Santiago, Chile
[11] Hosp Univ Cent Asturia, Hematol Pediat, Oviedo, Spain
[12] Hosp Gregorio Maranon, Hematol Pediat, Madrid, Spain
[13] Hosp Malaga, Hematol Pediat, Malaga, Spain
[14] Hosp Santa Creu & Sant Pau, Hematol Aoncol Pediat, Barcelona, Spain
来源
TRANSPLANTATION AND CELLULAR THERAPY | 2024年 / 30卷 / 10期
关键词
Haploidentical transplantation; Cord blood transplantation; Acute myeloid leukemia; STEM-CELL TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; T-CELL; HIGH-RISK; POSTTRANSPLANT CYCLOPHOSPHAMIDE; IMMUNE RECONSTITUTION; WORKING PARTY; CHILDREN; DONOR; EXPANSION;
D O I
10.1016/j.jtct.2024.07.013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Haploidentical stem cell transplantation (Haplo-SCT) and cord blood transplantation (CBT) are both effective alternative treatments in patients suffering from acute myeloid leukemia (AML) and lacking a matched HLA donor. In the last years, many centers have abandoned CBT procedures mostly due to concern about poorer immune recovery compared with Haplo-SCT. We conducted a retrospective multicenter study comparing the outcomes using both alternative approaches in AML. A total of 122 transplants (86 Haplo-SCTs and 36 CBTs) from 12 Spanish centers were collected from 2007 to 2021. Median age at hematopoietic stem cell transplantation (HSCT) was 7 years (0.4-20). Thirty-nine patients (31.9%) showed positive minimal residual disease (MRD) at HSCT and a previous HSCT was performed in 37 patients (30.3%). The median infused cellularity was 14.4 x 10(6)/kg CD34+ cells (6.0-22.07) for Haplo-SCT and 4.74 x 10(5)/kg CD34+ cells (0.8-9.4) for CBT. Median time to neutrophil engraftment was 14 days (7-44) for Haplo-SCT and 17 days (8-29) for CBT (P = .03). The median time to platelet engraftment was 14 days (6-70) for Haplo-SCT and 43 days (10-151) for CBT (P < .001). Graft rejection was observed in 13 Haplo-SCTs (15%) and in 6 CBTs (16%). The cumulative incidence of acute graft versus host disease (GvHD) grades II-IV was 54% and 51% for Haplo-SCT and CBT, respectively (P = .50). The cumulative incidence of severe acute GvHD (grades III-IV) was 22% for Haplo-SCT and 25% for CBT (P = .90). There was a tendency to a higher risk of chronic GvHD in the Haplo-SCT group being the cumulative incidence of 30% for Haplo-SCT and 12% for CBT (P = .09). The cumulative incidence of relapse was 28% and 20% for Haplo-SCT and CBT, respectively (P = .60). We did not observe statistically significant differences in outcome measures between Haplo-SCT and CBT procedures: 5-year overall survival (OS) was 64% versus 57% (P = .50), 5-year disease-free survival (DFS) 58% versus 57% (P = .80), GvHD-free and relapse-free survival (GFRFS) 41% versus 54% (P = .30), and cumulative incidence of transplant-related mortality (TRM) 14% versus 15% (P = .80), respectively. In the multivariate analysis, MRD positivity and a disease status >CR1 at the time of HSCT were significantly associated with poorer outcomes (P < .05). In conclusion, our study supports that both haploidentical and cord blood transplantation show comparable outcomes in pediatric AML patients. We obtained comparable survival rates, although CBT showed a trend to lower rates of chronic GvHD and higher GFRFS, demonstrating that it should still be considered a valuable option, particularly for pediatric patients. (c) 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
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收藏
页码:1015e1 / 1015e13
页数:13
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