Paediatricallogeneic stem cell transplantation: experience from developing world
Introduction: There is lack of data for pediatric allogeneic stem cell transplant (allo-SCT) from a developing country like India. We describe here our experience of allo-SCT programme at Sir Ganga Ram Hospital, a tertiary hospital in North India. Patients and Methods: A retrospective analysis of all children who underwent allo-SCT from Jan 2008 to Oct 2011 was done. Results: A total of 28 children (17 males and 11 females) underwent allo-SCT. The mean age was 11.2 years (11 months-18 years). The indications were Thalassemia-13, Aplastic anemia-6, Acute myeloid leukemia (AML)-3, Acute lymphoblastic leukemia- 1, Juvenile myelomocytic leukemia-1, Familial Hemophagocytic Lymphohistiocytosis (HLH)-2, Fanconi Anemia-1, Hurler syndrome-1. Donors were HLA-matched sibling-23 and unrelated cord blood-5. The source of stem cells was peripheral blood (PB)-11, bone marrow (BM)-12 and cord blood (CB)-6. One patient received CB and BM from same sibling. 23 patients underwent myeloablative transplants and 5 had reduced intensity conditioning (HLH-2, Thalassemia-1, AML-1, Fanconi-1). Three donor lymphocyte infusions were given to one patient. Neutrophil engrafted in 26 patients at a median of 14 days (range 11 to 44). Four patients had rejection (Thalassemia-2, aplastic-1, Fanconi-1) but all are alive with disease. Eighteen patients (64%) are alive and disease free at a median follow-up of 253 days (65-591 days). Day-100 mortality was 3/28 (11%). Cause of death was Graft vs. Host Disease (GVHD)-1, Veno Occlusive Disease- 1 and Candida meningitis-1. Three patients died post day-100 due to relapse-1, cytomegalovirus-1 and aspergillus-1. Engraftment syndrome was seen post CB transplant in one child. Acute GVHD was seen in 12 patients (PB-8, CB-1, BM-3), grade III-IV was seen in 4 patients (PB-4). Chronic GVHD was seen in 6 /28 (source BM-1, PB-4). Massive bleeding (gastro-intestinal-2 and pulmonary-1) occurred in three children. Two patients developed sinusoidal obstruction syndrome. Among 5 unrelated CB transplant patients, 4 engrafted. One with AML relapsed at 184 days and died, another with HLH who had received campath based conditioning died of cytomegalovirus infection at day 154 days and one with thalassemia had rejection but is alive post autologous transplant. Two patients are alive and disease free (Thalassemia-1, Hurler-1). Conclusion: Our results are encouraging and give hope to many children who need allogeneic stem cell transplant in the developing world.
Full conference title:
Annual Meeting of the EBMT, 38th