Transplantation of the bone marrow from a HLA-compatible unrelated donor after immunoablative conditioning in children with acquired aplastic anemia unresponsive to combined immunosuppressive therapy: Preliminary results
- Authors: Novichkova GA1, Maschan MA1, Shipitsyna IP2, Skvortsova Y.V2, Persiantseva MI1, Lebedeva LL2, Bobrynina VO1, Baidildina DD2, Goronkova OV2, Solopova GG2, Khachatryan LA1, Petrova UN1, Suntsova EV2, Kalinina II1, Sinitsyna VV1, Skorobogatova EV2, Balashov DN3, Dyshlevaya ZM2, Shelikhova LN2, Kurnikova EE2, Trakhtman PE2, Maschan AA1
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Affiliations:
- Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
- Russian Children's Hospital, Moscow
- Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationRussian Children's Hospital, Moscow
- Issue: Vol 82, No 7 (2010)
- Pages: 41-47
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/30622
- ID: 30622
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Full Text
Abstract
Subjects and methods. The study enrolled 14 children aged 2-16 years (median 9 years). A control group comprised 26 patients in whom IST was continued. The median interval between the diagnosis of AA and transplantation was 26 months (9-156 months). The conditioning regimen consisted of thoracoabdominal irradiation in a dose of 2 Gy, fludarabin (Flu) 100-150 mg/m2, cyclophosphamide (Cy) 100-200 mg/kg, antithymocyte globulin (ATG) in 11 patients and Flu, Cy, and ATG in 3. A graft-versus-host reaction was prevented with mycophenolate mefetil in all the patients, tacrolimus in 11, and cyclosporin A in 3. Donors were compatible for high-resolution typing of 10/10 and 9/10 alleles in 8 and 6 patients, respectively; the source of a transplant was bone marrow in 13 patients and granulocyte colony-stimulating factor-mobilized peripheral blood precursors in one case.
Results. Thirteen patients achieved primary engraftment after single transplantation; one patient did after repeat transplantation. Grades I to II graft-versus-host reaction (GVHR) developed in 9 patients; postengraftment life-threatening infections in 3, extensive chronic GVHR in 2, circumscribed GVHR in 7. All fourteen hemopoietic cell transplant recipients followed for a median 17.5 months (range 1-71 months) were survivors.
Conclusion. The likelihood of good survival after unrelated transplantations in AA is much higher than that after continued IST: 100% versus 15±11%.
About the authors
G A Novichkova
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
M A Maschan
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
I P Shipitsyna
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
Yu V Skvortsova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
M I Persiantseva
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
L L Lebedeva
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
V O Bobrynina
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
D D Baidildina
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
O V Goronkova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
G G Solopova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
L A Khachatryan
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
U N Petrova
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
E V Suntsova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
I I Kalinina
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
V V Sinitsyna
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
E V Skorobogatova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
D N Balashov
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationRussian Children's Hospital, MoscowFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationRussian Children's Hospital, Moscow
Z M Dyshlevaya
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
L N Shelikhova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
E E Kurnikova
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
P E Trakhtman
Russian Children's Hospital, MoscowRussian Children's Hospital, Moscow
A A Maschan
Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian FederationFederal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Ministry of Health of the Russian Federation
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