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Comparison of outcomes of hematopoietic stem cell transplantation without chemotherapy conditioning by using matched sibling and unrelated donors for treatment ofsevere combined immunodeficiency

  • Author(s): Dvorak, CC
  • Hassan, A
  • Slatter, MA
  • Hönig, M
  • Lankester, AC
  • Buckley, RH
  • Pulsipher, MA
  • Davis, JH
  • Güngör, T
  • Gabriel, M
  • Bleesing, JH
  • Bunin, N
  • Sedlacek, P
  • Connelly, JA
  • Crawford, DF
  • Notarangelo, LD
  • Pai, S-Y
  • Hassid, J
  • Veys, P
  • Gennery, AR
  • Cowan, MJ
  • et al.

Published Web Location

http://10.0.3.248/j.jaci.2014.06.021
No data is associated with this publication.
Abstract

Background: Patients with severe combined immunodeficiency disease who have matched sibling donors (MSDs) can proceed to hematopoietic cell transplantation (HCT) without conditioning chemotherapy. Objective: We sought to determine whether the results of HCT without chemotherapy-based conditioning from matched unrelated donors (URDs), either from volunteer adults or umbilical cord blood, are comparable with those from MSDs. Methods: We performed a multicenter survey of severe combined immunodeficiency transplantation centers in North America, Europe, and Australia to compile retrospective data on patients who have undergone unconditioned HCT from either URDs (n= 37) or MSDs (n= 66). Results: Most patients undergoing URD HCT (92%) achieved donor T-cell engraftment compared with 97% for those with MSDs; however, estimated 5-year overall and event-free survival were worse for URD recipients (71% and 60%, respectively) compared with MSD recipients (92% and 89%, respectively; P< .01 for both). URD recipients who received pre-HCT serotherapy had similar 5-year overall survival (100%) to MSD recipients. The incidences of grade II to IV acute and chronic graft-versus-host disease were higher in URD (50% and 39%, respectively) compared with MSD (22% and 5%, respectively) recipients ( P< .01 for both). In the surviving patients there was no difference in T-cell reconstitution at the last follow-up between the URD and MSD recipients; however, MSD recipients were more likely to achieve B-cell reconstitution (72% vs 17%, P< .001). Conclusion: Unconditioned URD HCT achieves excellent rates of donor T-cell engraftment similar to that seen in MSD recipients, and reconstitution rates are adequate. However, only a minority will have myeloid and B-cell reconstitution, and attention must be paid to graft-versus-host disease prophylaxis. This approach might be safer in children ineligible for intense regimens to spare the potential complications of chemotherapy. © 2014 American Academy of Allergy, Asthma & Immunology.

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