Treatment of graft failure with TNI-based reconditioning and haploidentical stem cells in paediatric patients
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Treatment of graft failure with TNI-based reconditioning and haploidentical stem cells in paediatric patients. / Teltschik, Heiko-Manuel; Heinzelmann, Frank; Gruhn, Bernd; Feuchtinger, Tobias; Schlegel, Patrick; Schumm, Michael; Kremens, Bernhard; Müller, Ingo; Ebinger, Martin; Schwarze, Carl Philipp; Ottinger, Hellmut; Zips, Daniel; Handgretinger, Rupert; Lang, Peter.
in: BRIT J HAEMATOL, Jahrgang 175, Nr. 1, 24.06.2016, S. 115-22.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Treatment of graft failure with TNI-based reconditioning and haploidentical stem cells in paediatric patients
AU - Teltschik, Heiko-Manuel
AU - Heinzelmann, Frank
AU - Gruhn, Bernd
AU - Feuchtinger, Tobias
AU - Schlegel, Patrick
AU - Schumm, Michael
AU - Kremens, Bernhard
AU - Müller, Ingo
AU - Ebinger, Martin
AU - Schwarze, Carl Philipp
AU - Ottinger, Hellmut
AU - Zips, Daniel
AU - Handgretinger, Rupert
AU - Lang, Peter
N1 - © 2016 John Wiley & Sons Ltd.
PY - 2016/6/24
Y1 - 2016/6/24
N2 - Graft failure is a life-threatening complication after allogeneic haematopoietic stem cell transplantation (HSCT). We report a cohort of 19 consecutive patients (median age: 8·5 years) with acute leukaemias (n = 14) and non-malignant diseases (n = 5) who experienced graft failure after previous HSCT from matched (n = 3) or haploidentical donors (n = 16) between 2003 and 2012. After total nodal irradiation (TNI)-based reconditioning combined with fludarabine, thiotepa and anti-T cell serotherapy, all patients received T cell-depleted peripheral blood stem cell grafts from a second, haploidentical donor. Median time between graft failure and retransplantation was 14 d (range 7-40). Sustained engraftment (median: 10 d, range 9-32) and complete donor chimerism was observed in all evaluable patients. 5 patients additionally received donor lymphocyte infusions. Graft-versus-host disease (GvHD) grade II and III occurred in 1 patient each (22%); no GvHD grade IV was observed. 2 patients had transient chronic GvHD. The regimen was well tolerated with transient interstitial pneumonitis in one patient. Treatment-related mortality after one year was 11%. Event-free survival and overall survival 3 years after retransplantation were 63% and 68%. Thus, a TNI-based reconditioning regimen followed by transplantation of haploidentical stem cells is an option to rescue patients with graft failure within a short time span and with low toxicity.
AB - Graft failure is a life-threatening complication after allogeneic haematopoietic stem cell transplantation (HSCT). We report a cohort of 19 consecutive patients (median age: 8·5 years) with acute leukaemias (n = 14) and non-malignant diseases (n = 5) who experienced graft failure after previous HSCT from matched (n = 3) or haploidentical donors (n = 16) between 2003 and 2012. After total nodal irradiation (TNI)-based reconditioning combined with fludarabine, thiotepa and anti-T cell serotherapy, all patients received T cell-depleted peripheral blood stem cell grafts from a second, haploidentical donor. Median time between graft failure and retransplantation was 14 d (range 7-40). Sustained engraftment (median: 10 d, range 9-32) and complete donor chimerism was observed in all evaluable patients. 5 patients additionally received donor lymphocyte infusions. Graft-versus-host disease (GvHD) grade II and III occurred in 1 patient each (22%); no GvHD grade IV was observed. 2 patients had transient chronic GvHD. The regimen was well tolerated with transient interstitial pneumonitis in one patient. Treatment-related mortality after one year was 11%. Event-free survival and overall survival 3 years after retransplantation were 63% and 68%. Thus, a TNI-based reconditioning regimen followed by transplantation of haploidentical stem cells is an option to rescue patients with graft failure within a short time span and with low toxicity.
U2 - 10.1111/bjh.14190
DO - 10.1111/bjh.14190
M3 - SCORING: Journal article
C2 - 27341180
VL - 175
SP - 115
EP - 122
JO - BRIT J HAEMATOL
JF - BRIT J HAEMATOL
SN - 0007-1048
IS - 1
ER -