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• W2089510292 abstract "Myeloablative AlloSCT is associated with 20-40% non-relapse mortality (NRM) in the first 100 days. NRM depends in large part on graft source, disease and disease status and possibly intensity of conditioning. RTC may decrease NRM but pediatric data are limited (Satwani/Cairo BBMT, 2005). We evaluated the feasibility and toxicity of RTC-AlloSCT in 100 consecutive children (median age 9.23±6.79 yrs) with malignant disease (50) or non-malignant disease (50) undergoing UCB (n = 51), MFD (n = 41), or MUD (n = 8) AlloSCT (89 average risk, 11 high risk). Regimens included Busulfan (6.4-8mg/kg) + Fludarabine (150-180mg/m2) ± ATG (8mg/m2) (n = 45); Cyclophosphamide (60mg/kg) + Fludarabine (150mg/m2) ± ATG (8mg/m2) (n = 20); and Busulfan (12.8-16mg/kg) + Fludarabine (150mg/m2) + Alemtuzumab (54mg/m2) (n = 35). Mean follow-up is 1277 ±1041 days. Time to neutrophil and platelet engraftment was 19 ±10 days and 35 ± 26.6 days, respectively. Donor chimerism on day 30, 100 and 365 was 86 ±27, 92.6 ±15.8 and 93±16, respectively. Cumulative incidence of aGVHD and cGVHD was 24.7%±4.8% and 18.6%±4.7%, respectively. Day 100 and 5 year NRM was 4.1%±2.01% and 15±3.9 %, respectively. Overall incidence of primary graft failure (PGF) was 16.5%±3.7%. Incidence of PGF with UCB was 33.3%±6.8% vs. 0% for MUD and MSD (p < 0.0001). Incidence of PGF with UCB in chemo-naive vs. non-chemo-naive patients was 48.3%±9.3% vs. 10.5%±7 % (p < 0.0072). The 5 year probability of OS and EFS was 69%±5% and 56.4%±5.4%, respectively. On univariate analysis, age (p = 0.12), malignant disease (p = 0.1), UCB (p = 0.02), poor risk disease (p = 0.001), chemo-naive patients (p = 0.1), fungal infection (p = 0.01), alemtuzumab based RTC (p = 0.03) and PGF (p = 0.03) were associated with poor OS. However, on Cox proportional hazard model based multivariate analysis only graft failure (p = 0.028) and poor risk disease (p = 0.03) were associated with poor OS. In summary, in this largest reported pediatric series, RTC-AlloSCT demonstrated substantially reduced day 100 NRM and sustained donor chimerism. However, chemo-naive children undergoing RTC-AlloSCT with UCB grafts have a higher incidence of PGF, and poor OS." @default.
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• W2089510292 date "2011-02-01" @default.
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• W2089510292 title "Reduced Toxicity Conditioning (RTC) and Allogeneic Stem Cell Transplantation (alloSCT) in 100 Consecutive Pediatric Recipients: Very Low Incidence of Day 100 Transplant Related Mortality (TRM)" @default.
• W2089510292 doi "https://doi.org/10.1016/j.bbmt.2010.12.336" @default.
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