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Outcome After Cord Blood Transplantation Using Busulfan Pharmacokinetics-Targeted Myeloablative Conditioning for Hurler Syndrome
- Source :
- Transplantation and cellular therapy. 27(1)
- Publication Year :
- 2020
-
Abstract
- We report the outcomes of cord blood transplantation (CBT) with a busulfan (Bu) pharmacokinetics-targeted myeloablative conditioning regimen in 97 children with Hurler syndrome (HS) performed between 2004 and 2016. The median age at CBT was 10.8 months (range, 0.23 to 63.2 months). The median duration of follow-up for surviving patients was 4.2 years (range, 1.0 to 12.8 years). Five-year overall survival (OS) and engrafted survival (ES) were 88% and 79%, respectively. OS was 95% in patients who received Bu/fludarabine (Flu)/antithymocyte globulin (ATG) conditioning, 90% in those who received Bu/cyclophosphamide (Cy)/ATG, and 74% in those who received Bu/Cy/alemtuzumab (P = .02). ES was 84% for recipients of Bu/Flu/ATG conditioning, 83% for recipients of Bu/Cy/ATG conditioning, and 65% for recipients of Bu/Cy/alemtuzumab conditioning (P = .34). Receipt of washed CB units (P = .03) and HLA matching ≤6/10 (P = .02) were associated with significantly lower ES. The 1-year cumulative incidence of graft failure was 11% (95% confidence interval, 6% to 21%). Five patients (5%) had grade III-IV acute GVHD, 5 patients had limited chronic GVHD, and 1 patient had extensive GVHD. The incidence of veno-occlusive disease was higher in patients conditioned with Bu/Cy compared with those conditioned with Bu/Flu (19% [n = 10] versus 5% [n = 2]: P = .03). Of the 11 patients with graft failure, 8 (73%) were aplastic, and 3 (27%) had autologous reconstitution. Of 11 patients with graft failure, 9 underwent a second CBT, and 8 (89%) survived. Full donor chimerism was observed in 89% patients after first CBT and in all patients after second CBT. Survival after CBT for HS has improved, but better strategies are still needed to improve graft outcomes.
- Subjects :
- medicine.medical_specialty
Transplantation Conditioning
Cyclophosphamide
Mucopolysaccharidosis I
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Pharmacokinetics
Internal medicine
medicine
Immunology and Allergy
Humans
Cumulative incidence
Hurler syndrome
Child
Busulfan
Retrospective Studies
Transplantation
business.industry
Incidence (epidemiology)
Cell Biology
Hematology
medicine.disease
Fludarabine
030220 oncology & carcinogenesis
Molecular Medicine
Alemtuzumab
Cord Blood Stem Cell Transplantation
business
030215 immunology
medicine.drug
Subjects
Details
- ISSN :
- 26666367
- Volume :
- 27
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Transplantation and cellular therapy
- Accession number :
- edsair.doi.dedup.....7e17939ba8865dec0cc5c9ce8d294ad7