Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation – A comparison of the last two decades

Abstract

Pediatric protocols for allogeneic hematopoietic SCT have been altered during the last two decades. To compare the outcomes in children (<18 yr old), who underwent SCT at our center during 1992-2002 (P1) and 2003-2013 (P2). We retrospectively analyzed 188 patients in P1 and 201 patients in P2. The most significant protocol changes during P2 compared with P1 were a decrease in MAC protocols, particularly those containing TBI, an increase in RIC protocols, and altered GvHD prophylaxis. In addition, P2 had more patients with nonmalignant diagnoses (p = 0.002), more mismatched (MM) donors (p = 0.01), and more umbilical CB grafts (p = 0.03). Mesenchymal or DSCs were used for severe acute GvHD during P2. Three-yr OS in P1 was 58%, and in P2, it was 78% (p < 0.001). Improved OS was seen in both malignant disorders (51% vs. 68%; p = 0.05) and nonmalignant disorders (77% vs. 87%; p = 0.04). Multivariate analysis showed that SCT during P2 was associated with reduced mortality (HR = 0.57; p = 0.005), reduced TRM (HR = 0.57; p = 0.03), unchanged relapse rate, similar rate of GF, less chronic GvHD (HR = 0.49; p = 0.01), and more acute GvHD (HR = 1.77, p = 0.007). During recent years, OS has improved at our center, possibly reflecting the introduction of less toxic conditioning regimens and a number of other methodological developments in SCT.

Long-Term Effects of Haematopoietic Stem Cell Transplantation after Pediatric Cancer: A Qualitative Analysis of Life Experiences and Adaptation Strategies

“…From a medical perspective, different authors showed over the last 25 years an increase in HSCT complexity but also major advances in supportive care and a refinement of donor selection (Mateos et al, 2013; Brissot et al, 2016; Svenberg et al, 2016). All these developments have probably impacted on the physical and psychosocial consequences following HSCT after a pediatric cancer.…”

Haploidentical hematopoietic stem cell transplantation with post‐transplant high‐dose cyclophosphamide in high‐risk children: A single‐center study

“…This is consistent with previous reports and we think that, in spite of doubts due to HLA incompatibility, there is no evidence that engraftment is unlikely to occur in haplo‐transplants when Post‐Cy treatment is included. Another considerable finding in this study was that the incidences of acute and chronic GVHD were comparable to those in previous reports of T‐cell replete and depleted haplo‐transplantations, as well as those in conventional HLA‐matched transplantations . Since leaving all T cells in the haploidentical graft results in excessive rates of severe GVHD and removing all T cells from the graft results in unacceptable rates of graft failure, it is obvious that unmanipulated haplo‐transplantation with Post‐Cy is especially beneficial as it is able to prevent both GVHD and graft failure to a large extent.…”

Strong expression of p53 protein in bone marrow samples after hematopoietic stem cell transplantation indicates risk of relapse in pediatric acute lymphoblastic leukemia patients

“…However, a small group of ALL patients relapse after initial treatment or have a high level of MRD despite treatment and thereby become candidates for HSCT. After HSCT, approximately 30% of patients still relapse and these patients have a poor prognosis . Monitoring of MRD and chimerism are current analyses used to detect early relapse after HSCT and the results may affect treatment by, for example, lowering the immunosuppression.…”