Unrelated Donor Transplantation in Children with Thalassemia using Reduced-Intensity Conditioning: The URTH Trial
Year: 2018
Type: article
Abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) can cure transfusion-dependent thalassemia (TDT). In a multicenter trial we investigated the efficacy of reduced-intensity conditioning (RIC) before unrelated donor (URD) HSCT in children with TDT. Thirty-three children, ages 1 to 17 years, received bone marrow (BM) or umbilical cord blood (UCB) allografts. Median time to neutrophil engraftment was 13 days (range, 10 to 25) and 24 days (range, 18 to 49) and platelet engraftment 23 days (range, 12 to 46) and 50 days (range, 31 to 234) after BM and UCB allografts, respectively. With a median follow-up of 58 months (range, 7 to 79), overall and thalassemia-free survival was 82% (95% CI, .64% to .92%) and 79% (95% CI, .6% to .9%), respectively. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) after BM and UCB allografts was 24% and 44%; the 2-year cumulative incidence of chronic extensive GVHD was 29% and 21%, respectively; 71% of BM and 91% of UCB recipients discontinued systemic immunosuppression by 2 years. Six patients who had Pesaro risk class 2 (n = 5) and class 3 (n = 1) died of GVHD (n = 3), viral pneumonitis (n = 2) and pulmonary hemorrhage (n = 1). Outcomes after this RIC compared favorably with URD HSCT outcomes for TDT and supported engraftment in 32 of 33 patients. Efforts to reduce GVHD and infectious complications are being pursued further.
Authors: Shalini Shenoy, Mark C. Walters, Alex Ngwube, Sandeep Soni, David Jacobsohn, Sonali Chaudhury, Michael Grimley, Kawah Chan, Ann Haight, Kimberley A. Kasow, Suhag Parikh, Martin Andreansky, Jim Connelly, David Delgado, Kamar Godder, Gregory Hale, Michael Nieder, Michael A. Pulsipher, Felicia Trachtenberg, Ellis Neufeld, Janet L. Kwiatkowski, Alexis A. Thompson
Institutions: St. Louis Children's Hospital, Washington University in St. Louis, University of California, San Francisco, UCSF Benioff Children's Hospital, Phoenix Children's Hospital, Nationwide Children's Hospital, Lucile Packard Children's Hospital, Stanford University, Children's National, Northwestern University, Lurie Children's Hospital, Emory University, Children's Healthcare of Atlanta, University of North Carolina at Chapel Hill, Duke Medical Center, University of Miami, University of Michigan, Riley Hospital for Children, Miami Children's Hospital, Johns Hopkins University, Johns Hopkins All Children's Hospital, Children's Hospital of Los Angeles, New England Research Institutes, St. Jude Children's Research Hospital, Children's Hospital of Philadelphia, University of Pennsylvania
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2786879641