Premature cyclosporine cessation and TBI-containing
conditioning regimen increase therisk ofacute GvHD
in children undergoing unrelated donor hematopoietic
stem cell transplantation

Szmit, Zofia; Kałwak, Krzysztof; Król, Anna; Mielcarek‐Siedziuk, Monika; Salamonowicz, Małgorzata; Frączkiewicz, Jowita; Ussowicz, Marek; Owoc‐Lempach, Joanna; Gorczyńska, Ewa

doi:10.17219/acem/103069

Cited by 3 publications

(1 citation statement)

References 37 publications

(45 reference statements)

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“…The 5-year OS rate was significantly lower among patients who received the TBI/Cy-based regimen (58.7% vs. 77.6%, P = 0.023) than among those who received the Bu/Cy-based regimen in the AD group. This may be related to the application of TBI to increase the risk of grade II-IV aGVHD, which in turn affects the survival of patients [45,46]. Grade II-IV aGVHD, conditioning regimen, and donorrecipient ABO status had no significant effect on 5-year OS among patients in the MSD group (all P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

Alternative donor peripheral blood stem cell transplantation for the treatment of high-risk refractory and/or relapsed childhood acute leukemia: a randomized trial

Zhang

Zhou

et al. 2020

Exp Hematol Oncol

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Background: The high-risk refractory and/or relapsed (R/R) childhood acute leukemia prognosis is poor, and allogeneic stem cell transplantation (allo-HSCT) is the most prudent treatment modality. However, there are limited matched sibling donors (MSDs), and alternative donors (ADs) are the main source for allo-HSCT. Thus, we evaluated the clinical efficacy of AD peripheral allo-HSCT for treating high-risk R/R childhood acute leukemia. Methods: We assessed 111 children who underwent allo-HSCT at the Affiliated Cancer Hospital of Zhengzhou University between October 2006 and July 2019. The patients were divided in the MSD and AD groups, and their clinical characteristics, complications, and survival rates were compared. Results: The cumulative incidences of Epstein-Barr virus and cytomegalovirus infections were significantly higher in the AD than in the MSD group (P < 0.001); however, the recurrence and mortality rates were significantly higher in the MSD than in the AD group (P < 0.05). Furthermore, the 5-year disease-free (DFS) (65.2% vs. 43.3%, P = 0.033) and overall survival (OS) rates (71.6% vs. 53.8%, P = 0.053) were significantly higher in the AD than in the MSD group. In the AD group, the grade II-IV acute graft-versus-host disease (aGVHD), donor-recipient ABO compatibility, conditioning regimen, and CMV infection affected the 5-year OS. The grade II-IV aGVHD also affected the 5-year DFS; however, only the donor-recipient ABO compatibility affected the 5-year DFS. The donor MSD (HR: 2.035, 95% confidence interval [CI] 1.057-3.920, P = 0.034) and the grade II-IV aGVHD (HR: 2.914, 95% CI 1.261-6.736, P = 0.012) affected the 5-year DFS of childhood acute leukemia after allo-HSCT, and the grade II-IV aGVHD (HR: 3.016, 95% CI 1.217-7.473, P = 0.017) affected the 5-year OS. Moreover, the donor source (HR: 2.836, 95% CI 1.179-6.823, P = 0.020) and grade II-IV aGVHD (HR: 3.731, 95% CI 1.332-10.454, P = 0.012) were independent predictors of the 5-year DFS, while the latter (HR: 3.524, 95% CI 1.310-10.988, P = 0.030) was an independent predictor of the 5-year OS. Conclusions: AD-PBSCT was effective for high-risk R/R childhood leukemia and may have better clinical outcomes than MSD-PBSCT; thus, it can be used as first-line treatment for high-risk R/R childhood leukemia.

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Section: Discussionmentioning

confidence: 99%

Alternative donor peripheral blood stem cell transplantation for the treatment of high-risk refractory and/or relapsed childhood acute leukemia: a randomized trial

Zhang

Zhou

et al. 2020

Exp Hematol Oncol

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Ciclosporin

2019

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Early withdrawal immunosuppression improved mixed chimerism in hematopoietic stem cell transplantation for pediatric aplastic anemia

Wang,

Qin,

Luo

et al. 2024

Preprint

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Mixed chimerism (MC) occurs frequently with the risk of graft reject (GR) for aplastic anemia (AA) patients undergoing matched sibling donor (MSD) hematopoietic stem cell transplantation (HSCT). So far, no one knows how to adjust immunosuppression (IS) during MC. We retrospectively analyzed 87 consecutive pediatric patients. Early withdrawal (EW) IS and donor lymphocyte infusion (DLI) were attempted to reverse MC. The rate of MC was 26% (n = 23). Low dose cyclophosphamide (CY) (120–150 mg/kg) is an independent risk factor for MC (P = 0.0002) and increase dosage of Fludarabine (FLU) cannot eliminated it. Patients receiving 200 mg/kg CY had the lowest MC rate (8%) and best 3-year graft-versus-host disease (GVHD)/failure free survival (GFFS; 95%). Chimerism in T cells is more sensitive than that in whole blood (P = 0.001). In 17 patients with early-onset MC (ratio of DLI: 83% versus 82%), EW IS strategy is helpful to improving complete chimerism (CC) (63 vs. 295 days, P = 0.008). Our study shows that FLU is necessary to intensify CY + ATG conditioning to maintain the engraftment and 200 mg/kg CY + 150 mg/m2 FLU is recommended as a basic conditioning regimen. EW IS strategy should be considered as an important option to improve donor chimerism in early-onset MC.

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Premature cyclosporine cessation and TBI-containing conditioning regimen increase therisk ofacute GvHD in children undergoing unrelated donor hematopoietic stem cell transplantation

Abstract: Szmit Z, Kałwak K, Król A, et al. Premature cyclosporine cessation and TBI-containing conditioning regimen increase the risk of acute GvHD in children undergoing unrelated donor hematopoietic stem cell transplantation.

Cited by 3 publications

References 37 publications

Alternative donor peripheral blood stem cell transplantation for the treatment of high-risk refractory and/or relapsed childhood acute leukemia: a randomized trial

Alternative donor peripheral blood stem cell transplantation for the treatment of high-risk refractory and/or relapsed childhood acute leukemia: a randomized trial

Ciclosporin

Early withdrawal immunosuppression improved mixed chimerism in hematopoietic stem cell transplantation for pediatric aplastic anemia

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