Allogeneic hematopoietic transplantation using haploidentical donor vs. unrelated cord blood donor in pediatric patients: a single-center retrospective study

Abstract

We retrospectively analyzed outcomes in 67 children with acute leukemia who received hematopoietic stem cell transplantation from alternative allogeneic donors: 29 received a haploidentical family donor and 38, an unrelated cord blood donor. All transplantations were performed from 1996 through 2010 in our center. Neutrophil and platelet engraftment were significantly delayed after cord blood transplantation. The median times to neutrophil and platelet recovery were 13 d (7-34) and 11 d (5-70) after haploidentical transplant and 20 d (9-125) and 56 d (12-200) after cord blood (P < 0.001). All supportive care measures included red blood cell, and platelet transfusions were significantly increased in cord blood transplantation group.Transplant-related mortality rates was lower with haplo donors (25 ± 9%) than with cord blood donors (47 ± 9%) (P< 0.05). Acute graft-versus-host disease (GVHD) more than grade II was also lower in haploidentical transplants (19 ± 7%) than in cord blood transplants (44 ± 10%) (P < 0.03). Relapse and chronic GVHD incidence were not significantly different in the two groups. Leukemia-free survival was higher after haploidentical transplants (44 ± 10%) than after cord blood transplants (33 ± 7%) (P < 0.03). Main differences were observed in patients diagnosed with acute lymphoblastic leukemia: haplo, 41 ± 13%; cord blood, 26 ± 9% (P < 0.03) and in advanced phase of disease: haplo, 37 ± 14%; cord blood, 21 ± 8% (P < 0.05). In conclusion, haploidentical transplants are a good and promising alternative option for patients with childhood leukemia who lack an human leukocyte antigen-matched donor (sibling or unrelated donor).

Haploidentical related-donor hematopoietic cell transplantation in children using megadoses of CliniMACs-selected CD34+ cells and a fixed CD3+ dose

“…24,26,28 Our data suggest that both approaches provide similar transplant outcomes, a conclusion also reached by other groups. 19 Leung et al 20 also demonstrated that, for children with acute leukemia, modern haploidentical HCT provides similar outcomes to both matched sibling and unrelated donor HCTs. Their results, in combination with ours and others, 19,21 suggest that haploidentical HCT should be more widely utilized for patients with otherwise incurable diseases.…”

“…19 Leung et al 20 also demonstrated that, for children with acute leukemia, modern haploidentical HCT provides similar outcomes to both matched sibling and unrelated donor HCTs. Their results, in combination with ours and others, 19,21 suggest that haploidentical HCT should be more widely utilized for patients with otherwise incurable diseases. One situation where haploidentical transplant may be preferable over cord blood is when attempting posttransplant immune manipulation via DLI to reduce relapse 29 or treat opportunistic infections.…”

“…4,17,18 However, combining CD34-selected haploidentical cells with a fully myeloablative conditioning regimen for patients with malignancy has been more fully explored in adult patients, 1,2 though some pediatric reports exist. [19][20][21] Fewer reports have focused on children with life-threatening nonmalignant diseases, [21][22][23] where the use of UCB stem cells predominates because many children are an appropriate size to receive the small cell dose in an UCB unit. For larger children and adults, two UCB units can be combined.…”

Refinement of treatment strategies in ex vivo T-cell-depleted haploidentical SCT for pediatric patients

“…[10][11][12][13][14] Although all of our patients received GVHD prophylaxis with calcineurin inhibitors and mycophenolate mofetil, the incidences of severe acute and chronic GVHD were acceptable for our partial depletion of T cells.…”

“…There have been several reports on HHCT using CD3-depleted grafts in pediatric patients. 2,[10][11][12][13][14] The Tübingen group reported their experience with CD3/19-depleted HHCT using reduced-intensity conditioning in 38 pediatric patients. 2 The authors reported a primary engraftment rate of 83%, with GR occurring in 17% of patients.…”