Unrelated hematopoietic stem cell transplantation in the pediatric population: single institution experience

Abstract

ObjectiveHematopoietic stem cell transplantation has been successfully used to treat the pediatric population with malignant and non-malignant hematological diseases. This paper reports the results up to 180 days after the procedure of all unrelated hematopoietic stem cell transplantations in pediatric patients that were performed in one institution.MethodsA retrospective review was performed of all under 18-year-old patients who received unrelated transplantations between 1995 and 2009. Data were analyzed using the log-rank test, Cox stepwise model, Kaplan–Meier method, Fine and Gray model and Fisher's exact test.ResultsThis study included 118 patients (46.8%) who received bone marrow and 134 (53.2%) who received umbilical cord blood transplants. Engraftment occurred in 89.47% of the patients that received bone marrow and 65.83% of those that received umbilical cord blood (p-value < 0.001). Both neutrophil and platelet engraftments were faster in the bone marrow group. Acute graft-versus-host disease occurred in 48.6% of the patients without statistically significant differences between the two groups (p-value = 0.653). Chronic graft-versus-host disease occurred in 9.2% of the patients with a higher incidence in the bone marrow group (p-value = 0.007). Relapse occurred in 24% of the 96 patients with malignant disease with 2-year cumulative incidences of 45% in the bone marrow group and 25% in the umbilical cord blood group (p-value = 0.117). Five-year overall survival was 47%, with an average survival time of 1207 days, and no significant differences between the groups (p-value = 0.4666).ConclusionDespite delayed engraftment in the umbilical cord blood group, graft-versus-host disease, relapse and survival were similar in both groups.

Awareness of cord blood collection and the impact on banking

“…The higher cost of the UCB product upfront is potentially mitigated with time due to the absence of prolonged therapy for chronic GVHD . In addition, UCB can be acquired quickly at no donor risk and has low virus transmission potential . Further, cord blood banks hold promise for future stem cell endeavors in the advancement of science.…”

Perfil Clínico De Crianças Submetidas a Transplante De Células-Tronco Hematopoiéticas

“…Assim, eleva-se o risco de complicações, intercorrências clínicas, reinternações e óbito. Estudos têm apontado complicações no período pós TCTH, tais como DECH e recidiva da doença, sendo a infecção uma das principais causas de morte (2,(11)(12) . Tais complicações podem ser responsáveis por intercorrências clínicas apresentadas; e interferir na recuperação, exigindo preparo de paciente e cuidador para o cuidado domiciliar.…”