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Treosulfan and Fludarabine Conditioning for Hematopoietic Stem Cell Transplantation in Children with Primary Immunodeficiency: UK Experience

Lookup NU author(s): Dr Mary Slatter, Dr Intan Abd Hamid, Dr Zohreh Nademi, Professor Mark Pearce, Dr Terence Flood, Dr Mario Abinun, Professor Sophie Hambleton, Professor Andrew Cant, Dr Andrew Gennery

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Abstract

© 2017 The American Society for Blood and Marrow Transplantation. We previously published results for 70 children who received conditioning with treosulfan and cyclophosphamide (n = 30) or fludarabine (n = 40) before undergoing hematopoietic stem cell transplantation (HSCT) for primary immunodeficiency (PID). Toxicity was lower and T cell chimerism was better in the patients receiving fludarabine, but cohort numbers were relatively small and follow-up was short. Here we report outcomes of 160 children who received homogeneous conditioning with treosulfan, fludarabine, and, in most cases, alemtuzumab (n = 124). The median age at transplantation was 1.36 years (range, .09 to 18.25 years). Donors included 73 matched unrelated, 54 1 to 3 antigen-mismatched unrelated, 12 matched sibling, 17 other matched family, and 4 haploidentical donors. Stem cell source was peripheral blood stem cells (PBSCs) in 70, bone marrow in 49, and cord blood in 41. Median duration of follow-up was 4.3 years (range, .8 to 9.4 years). Overall survival was 83%. No patients had veno-occlusive disease. Seventy-four patients (46%) had acute GVHD, but only 14 (9%) greater than grade II. Four patients underwent successful retransplantation for graft loss or poor immune reconstitution. Another patient experienced graft rejection and died. There was no association between T cell chimerism >95% and stem cell source, but a significant association was seen between myeloid chimerism >95% and use of PBSCs without an increased risk of significant GVHD compared with other sources. All 11 patients with severe combined immunodeficiency diagnosed at birth were alive at up to 8.7 years of follow-up. Long-term studies are needed to determine late gonadotoxic effects, and pharmacokinetic studies are needed to identify whether specific targeting is advantageous. The combination of treosulfan, fludarabine, and alemtuzumab is associated with excellent results in HSCT for PID.


Publication metadata

Author(s): Slatter MA, Rao K, Abd Hamid IJ, Nademi Z, Chiesa R, Elfeky R, Pearce MS, Amrolia P, Worth A, Flood T, Abinun M, Hambleton S, Qasim W, Gaspar HB, Cant AJ, Gennery AR, Veys P

Publication type: Article

Publication status: Published

Journal: Biology of Blood and Marrow Transplantation

Year: 2018

Volume: 24

Issue: 3

Pages: 529-536

Print publication date: 01/03/2018

Online publication date: 16/11/2017

Acceptance date: 08/11/2017

ISSN (print): 1083-8791

ISSN (electronic): 1523-6536

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.bbmt.2017.11.009

DOI: 10.1016/j.bbmt.2017.11.009


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