Similar outcome of upfront-unrelated and matched sibling stem cell transplantation in idiopathic paediatric aplastic anaemia. A study on behalf of the UK Paediatric BMT Working Party, Paediatric Diseases Working Party and Severe Aplastic Anaemia Working Party of EBMT

Carlo Dufour, Paul Veys, Elisa Carraro, Neha Bhatnagar, Marta Pillon, Rob Wynn, Brenda Gibson, Ajay J Vora, Colin G Steward, Anna M Ewins, Rachael E Hough, Josu de la Fuente, Mark Velangi, Persis J Amrolia, Roderick Skinner, Andrea Bacigalupo, Antonio M Risitano, Gerard Socie, Regis Peffault de Latour, Jakob PasswegAlicia Rovo, André Tichelli, Hubert Schrezenmeier, Britta Hochsmann, Peter Bader, Anja van Biezen, Mahmoud D Aljurf, Austin Kulasekararaj, Judith C Marsh, Sujith Samarasinghe

Research output: Contribution to journalArticle (Academic Journal)peer-review

88 Citations (Scopus)

Abstract

We explored the feasibility of unrelated donor haematopoietic stem cell transplant (HSCT) upfront without prior immunosuppressive therapy (IST) in paediatric idiopathic severe aplastic anaemia (SAA). This cohort was then compared to matched historical controls who had undergone first-line therapy with a matched sibling/family donor (MSD) HSCT (n = 87) or IST with horse antithymocyte globulin and ciclosporin (n = 58) or second-line therapy with unrelated donor HSCT post-failed IST (n = 24). The 2-year overall survival in the upfront cohort was 96 ± 4% compared to 91 ± 3% in the MSD controls (P = 0·30) and 94 ± 3% in the IST controls (P = 0·68) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (P = 0·02).The 2-year event-free survival in the upfront cohort was 92 ± 5% compared to 87 ± 4% in MSD controls (P = 0·37), 40 ± 7% in IST controls (P = 0·0001) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (n = 24) (P = 0·02). Outcomes for upfront-unrelated donor HSCT in paediatric idiopathic SAA were similar to MSD HSCT and superior to IST and unrelated donor HSCT post-IST failure. Front-line therapy with matched unrelated donor HSCT is a novel treatment approach and could be considered as first-line therapy in selected paediatric patients who lack a MSD.

Original languageEnglish
Pages (from-to)585-94
Number of pages10
JournalBritish Journal of Haematology
Volume171
Issue number4
DOIs
Publication statusPublished - Nov 2015

Keywords

  • Adenoviridae Infections
  • Adolescent
  • Adult
  • Anemia, Aplastic
  • Antilymphocyte Serum
  • Blood Transfusion
  • Bone Marrow Transplantation
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cyclosporine
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Graft vs Host Disease
  • Herpesviridae Infections
  • Histocompatibility
  • Humans
  • Immunosuppressive Agents
  • Infant
  • Kaplan-Meier Estimate
  • Length of Stay
  • Living Donors
  • Male
  • Peripheral Blood Stem Cell Transplantation
  • Postoperative Complications
  • Primary Graft Dysfunction
  • Quality of Life
  • Retrospective Studies
  • Siblings
  • Survival Rate
  • T-Lymphocytes
  • Treatment Outcome
  • Virus Activation
  • Young Adult
  • Comparative Study
  • Journal Article

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