Haploidentical Hematopoietic Cell Transplantation Using Post-transplant Cyclophosphamide for Children with Non-malignant Diseases.
Hasan HashemRula NajjarMayada Abu-ShanapEman KhattabRawad RihaniAbdelghani TbakhiIyad SultanPublished in: Journal of clinical immunology (2021)
Haploidentical hematopoietic cell transplantation (HCT) is a valuable curative option for children with non-malignant diseases. Haploidentical HCT using post-transplant cyclophosphamide (PTCy) is a readily available option in the absence of an HLA-matched donor. We conducted a retrospective single-center study on the outcome of haploidentical HCT in children with non-malignant diseases. We gathered data from 44 patients underwent HCT in the period 2015 to 2020. The indications for HCT were bone marrow failure, primary immunodeficiency, metabolic disorders, and hemoglobinopathy. Median age at HCT was 4 years (range 0.7-20). The conditioning regimens were myeloablative (n = 17) or reduced intensity (n = 27). After a median follow-up of 20 months (range 4-71), 2-year overall survival was 89% and 2-year GvHD-free relapse-free survival (GRFS) was 66%. Incidence of primary graft failure was 13.6%. Cumulative incidence of grade II-IV acute and moderate/severe chronic GvHD were 20% and 6.4%, respectively. Younger age at HCT (< 4 years) and primary immunodeficiency were significantly associated with better GRFS (p < 0.05). In conclusion, haploidentical HCT using PTCy is feasible and curative in children with non-malignant diseases lacking an HLA-matched donor. Early diagnosis and referral in addition to timely treatment can further improve outcomes.
Keyphrases
- bone marrow
- stem cell transplantation
- cell cycle arrest
- free survival
- young adults
- high dose
- peripheral blood
- prognostic factors
- cell death
- mesenchymal stem cells
- end stage renal disease
- newly diagnosed
- pi k akt
- risk factors
- chronic kidney disease
- rectal cancer
- type diabetes
- signaling pathway
- drug induced
- acute lymphoblastic leukemia
- artificial intelligence
- electronic health record
- big data
- respiratory failure
- skeletal muscle
- early onset
- acute respiratory distress syndrome
- insulin resistance
- mechanical ventilation
- deep learning
- patient reported