Retransplantation with stem cells from mismatched related donors after graft rejection in pediatric patients
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Retransplantation with stem cells from mismatched related donors after graft rejection in pediatric patients. / Lang, Peter; Müller, Ingo; Greil, Johann; Bader, Peter; Schumm, Michael; Pfeiffer, Matthias; Hoelle, Walter; Klingebiel, Thomas; Heinzelmann, Frank; Belka, Claus; Schlegel, Paul G; Kremens, Bernhard; Woessmann, Wilhelm; Handgretinger, Rupert.
in: BLOOD CELL MOL DIS, Jahrgang 40, Nr. 1, 22.09.2007, S. 33-9.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Retransplantation with stem cells from mismatched related donors after graft rejection in pediatric patients
AU - Lang, Peter
AU - Müller, Ingo
AU - Greil, Johann
AU - Bader, Peter
AU - Schumm, Michael
AU - Pfeiffer, Matthias
AU - Hoelle, Walter
AU - Klingebiel, Thomas
AU - Heinzelmann, Frank
AU - Belka, Claus
AU - Schlegel, Paul G
AU - Kremens, Bernhard
AU - Woessmann, Wilhelm
AU - Handgretinger, Rupert
PY - 2007/9/22
Y1 - 2007/9/22
N2 - Graft failure is a life-threatening complication after transplantation of hematopoietic stem cells. We report a cohort of 11 pediatric patients with leukemias (n=8) and severe aplastic anemia (n=3) who experienced graft rejection after myeloablative transplantation from mismatched related donors (n=6) or after cord blood or matched unrelated donor transplantation (n=5). In the latter, the original donor was not available anymore. All patients were re-transplanted with CD34(+) selected or CD3/CD19 depleted stem cells from a second, haploidentical donor. Median time span from diagnosis of rejection to second transplant was 9 days. Reconditioning regimens comprised total lymphoid irradiation, thiotepa, fludarabine, ATG/OKT3 and were well tolerated. A median number of 23.5x10(6)/kg stem cells with 95,000/kg residual T-cells were infused. Sustained engraftment of neutrophiles/platelets and complete donor chimerism was achieved in all patients (ANC>500/microl: 9 (11-32) days). No GvHD>grade II was observed. 8/11 patients are disease free (median follow up 1.9 years; 1 year-EFS=72%). Causes of death were: pneumonitis, infection, relapse. Thus, haploidentical transplantation represents a realistic option to rescue patients with graft failure within a short time span, for whom a second donation from the original donor is not available. The use of different donors may contribute to avoid a second rejection.
AB - Graft failure is a life-threatening complication after transplantation of hematopoietic stem cells. We report a cohort of 11 pediatric patients with leukemias (n=8) and severe aplastic anemia (n=3) who experienced graft rejection after myeloablative transplantation from mismatched related donors (n=6) or after cord blood or matched unrelated donor transplantation (n=5). In the latter, the original donor was not available anymore. All patients were re-transplanted with CD34(+) selected or CD3/CD19 depleted stem cells from a second, haploidentical donor. Median time span from diagnosis of rejection to second transplant was 9 days. Reconditioning regimens comprised total lymphoid irradiation, thiotepa, fludarabine, ATG/OKT3 and were well tolerated. A median number of 23.5x10(6)/kg stem cells with 95,000/kg residual T-cells were infused. Sustained engraftment of neutrophiles/platelets and complete donor chimerism was achieved in all patients (ANC>500/microl: 9 (11-32) days). No GvHD>grade II was observed. 8/11 patients are disease free (median follow up 1.9 years; 1 year-EFS=72%). Causes of death were: pneumonitis, infection, relapse. Thus, haploidentical transplantation represents a realistic option to rescue patients with graft failure within a short time span, for whom a second donation from the original donor is not available. The use of different donors may contribute to avoid a second rejection.
KW - Adolescent
KW - Adult
KW - Cause of Death
KW - Cell Count
KW - Cell Separation
KW - Child
KW - Child, Preschool
KW - Cohort Studies
KW - Disease-Free Survival
KW - Graft Rejection
KW - Graft Survival
KW - Haplotypes
KW - Hematopoietic Stem Cell Transplantation
KW - Histocompatibility
KW - Humans
KW - Leukocyte Reduction Procedures
KW - Reoperation
KW - Transplantation Chimera
KW - Transplantation Conditioning
KW - Transplantation, Homologous
U2 - 10.1016/j.bcmd.2007.06.027
DO - 10.1016/j.bcmd.2007.06.027
M3 - SCORING: Journal article
C2 - 17884640
VL - 40
SP - 33
EP - 39
JO - BLOOD CELL MOL DIS
JF - BLOOD CELL MOL DIS
SN - 1079-9796
IS - 1
ER -