Abstract 4572

Background:

RIC has been applied mainly for elderly patients and patients with comorbidity to expand opportunity for such adult patients to undergo HSCT. The burden of late effects after HSCT followed by myeloablative conditioning is not negligible in pediatric patients. RIC should be introduced to avoid not only treatment related morbidity (TRM) but also late effects for children even if they are not ineligible for myeloablative transplantation. However, enhanced graft-versus-leukemia (GVL) effect by choosing an alternative donor in the setting of RIC-HSCT for pediatric ALL hasn't been clarified, so far.

Methods:

We retrospectively analyzed 22 children with ALL who underwent RIC followed by HSCT from an alternative donor between 2001 and 2008 in our institute.

Results:

The median age of 22 patients at HSCT was 9 years (range one year - 19 years). 8 patients in CR1, two in CR2 and 12 beyond CR2 underwent HSCT from an alternative donor followed by Flu 180mg/m2 and LPAM 140 mg/m2 containing RIC. 8 patients who relapsed after myeloablative HSCT and 5 patients with Ph1-ALL were included. Unrelated bone marrow (BM) in 7 patients and unrelated cord blood in 4 were transplanted. 11 patients were transplanted from a haplo-identical parent (8, BM; 3, selected CD34 positive peripheral blood mononuclear cells). Engraftment was confirmed in 21 transplants out of 22 (95.4%). Death of TRM within 100 days after transplant was observed in 3/22 (13.6%). Acute graft-versus-host disease (GVHD) grade IV wasn't observed. Acute GVHD grade II and III occurred in 8/21 (38.1%) and 6/21 (28.6%), respectively. Chronic GVHD was seen in 8/16 (50%). 14 patients (63.6%) out of 22 are surviving after RIC-HSCT for median 36 months (range, 24 – 100 months). 9 patients (90%) out of 10 in CR1/CR2 and 5 (41.7%) out of 12 beyond CR2 are surviving.

Conclusion:

These results suggest RIC-HSCT from an alternative donor for pediatric ALL can be performed safely and similar outcome can be expected compared to myeloablative transplantation.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
acute lymphocytic leukemia, child, conditioning (psychology), donors, hematopoietic stem cell transplantation, transplantation, graft-versus-host disease, acute, leukemia, lymphocytic, acute, childhood, cd34 antigens, graft-versus-host disease

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
Sign in via your Institution