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Lum SH, Eikema DJ, Piepenbroek B, Wynn RF, Samarasinghe S, Dalissier A, Kalwak K, Ayas M, Hamladji RM, Yesilipek A, Dalle JH, Uckan-Cetinkaya D, Bierings M, Kupesiz A, Halahleh K, Skorobogatova E, Öztürk G, Faraci M, Renard C, Evans P, Corbacioglu S, Locatelli F, Dufour C, Risitano A, Peffault de Latour R. Outcomes of hematopoietic stem cell transplantation in 813 pediatric patients with Fanconi anemia. Blood 2024; 144:1329-1342. [PMID: 38968140 DOI: 10.1182/blood.2023022751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 07/07/2024] Open
Abstract
ABSTRACT Allogeneic hematopoietic stem cell transplantation (HSCT) is the only established curative option for Fanconi anemia (FA)-associated bone marrow failure (BMF)/aplastic anemia (AA) and acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS). We performed a retrospective multicenter study on 813 children with FA undergoing first HSCT between 2010 and 2018. Median duration of follow-up was 3.7 years. Median age at transplant was 8.8 years (IQR, 6.5-18.1). Five-year overall survival (OS), event-free survival (EFS), and graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) were 83% (95% confidence interval [CI], 80-86), 78% (95% CI, 75-81), and 70% (95% CI, 67-74), respectively. OS was comparable between matched family donor (MFD; n = 441, 88%) and matched unrelated donor (MUD; n = 162, 86%) and was superior to that of mismatched family donor (MMFD) or mismatched unrelated donor (MMUD; n = 144, 72%) and haploidentical donor (HID; n = 66, 70%; P < .001). In multivariable analysis, a transplant indication of AML/MDS (vs AA/BMF), use of MMFD/MMUD and HID (vs MFD), and fludarabine-cyclophosphamide (FluCy) plus other conditioning (vs FluCy) independently predicted inferior OS, whereas alemtuzumab vs antithymocyte globulin was associated with better OS. Age ≥10 years was associated with worse EFS and GRFS. Cumulative incidences (CINs) of primary and secondary graft failure were 2% and 3% respectively. CINs of grade 3 to 4 acute GVHD and chronic GVHD were 12% and 8% respectively. The 5-year CIN of secondary malignancy was 2%. These data suggest that HSCT should be offered to patients with FA with AA/BMF at a younger age in the presence of a well-matched donor.
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Affiliation(s)
- Su Han Lum
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | | | | | - Robert F Wynn
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | | | - Krysztof Kalwak
- Department of Pediatric Hematology, Oncology, and BMT, Wroclaw Medical University, Wroclaw, Poland
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | | - Jean-Hugues Dalle
- Hôpital Robert Debre, GHU Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
| | | | - Marc Bierings
- Princess Maxima Center/University Hospital for Children, Utrecht, The Netherlands
| | | | | | | | - Gülyüz Öztürk
- Acıbadem Sağlik Hizmetleri ve Ticaret AS, Istanbul, Turkey
| | - Maura Faraci
- Department of Hematology-Oncology, Hematology Unit, G. Gaslini IRCCS Institute, Genoa, Italy
| | - Cecile Renard
- Institut d'Hematologie et d'Oncologie Pediatrique, Hospices Civils de Lyon, Lyon, France
| | - Pamela Evans
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Franco Locatelli
- IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Dufour
- Department of Hematology-Oncology, Hematology Unit, G. Gaslini IRCCS Institute, Genoa, Italy
| | | | - Régis Peffault de Latour
- BMT Unit, French Reference Center for Aplastic Anemia and PNH, Hôpital Saint-Louis, Université Paris Cité, Paris, France
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Connelly JA, Savani BN. Irradiation-free, T-cell replete haploidentical transplant for Fanconi anaemia, weighing the benefits. Br J Haematol 2022; 199:639-641. [PMID: 36121005 DOI: 10.1111/bjh.18446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022]
Abstract
The optimal haploidentical haematopoietic cell transplant approach for Fanconi anaemia (FA) patients is not well established, given the rarity of the disease, the increased sensitivity to DNA-damaging agents and the high risk of severe graft-versus-host disease (GVHD). The report by Xu et al. suggests that excellent engraftment and short-term survival can be achieved in FA patients without irradiation, but their retrospective cohort was plagued by a high rate of severe GVHD. Our commentary explores the outcomes in T-cell replete haploidentical haematopoietic cell transplant and ponders whether elimination of total body irradiation in FA patients is the best method if it limits the ability to safely administer post-transplant cyclophosphamide.
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Affiliation(s)
- James A Connelly
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Xu L, Lu Y, Hu S, Li C, Tang Y, Wang H, Yan J, Chen J, Liu S, Sun Y, Wu X, Lin F, Lu P, Huang X. Unmanipulated haploidentical haematopoietic cell transplantation with radiation-free conditioning in Fanconi anaemia: A retrospective analysis from the Chinese Blood and Marrow Transplantation Registry Group. Br J Haematol 2022; 199:401-410. [PMID: 35989315 DOI: 10.1111/bjh.18408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/16/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
Haematopoietic cell transplantation (HCT) is the only curative treatment for haematological complications in patients with Fanconi anaemia (FA). Haploidentical (haplo-) HCT is a promising alternative for FA. We aimed to analyse the outcomes of unmanipulated haplo-HCT in patients with FA with radiation-free conditioning. A total of 56 patients from 11 centres between 2013 and 2021 in China were retrospectively analysed. The mean (SD) cumulative incidence was 96.4% (0.08%) for 30-day neutrophil engraftment and 85.5% (0.24%) for 100-day platelet engraftment. With a median (range) follow-up of 2.4 (0.2-5.8) years, favourable mean (SD) overall survival of 80.9% (5.5%) and event-free survival of 79.3% (5.6%) were achieved. The mean (SD) incidences of acute graft-versus-host disease (aGvHD) Grade II-IV and Grade III-IV were 55.4% (0.45%) and 42.9 (0.45%) respectively. The mean (SD) cumulative incidence of 3-year chronic graft-versus-host disease (cGvHD) was 34.7% (0.86%) and that of moderate-to-severe cGvHD was 9.0% (0.19%). Our data demonstrate that in unmanipulated haplo-HCT for patients with FA, radiation-free regimens based on fludarabine and low-dose cyclophosphamide ± busulfan achieved favourable engraftment and survival with relatively high incidences of aGvHD and cGvHD. These results prompt the use of low-intensity conditioning without radiation and intensive GvHD prophylaxis when considering unmanipulated haplo-HCT in patients with FA.
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Affiliation(s)
- Lanping Xu
- Peking University People's Hospital, Peking University Institute of Haematology, National Clinical Research Center for Haematologic Disease, Collaborative Innovation Center of Haematology, Beijing Key Laboratory of Haematopoietic Stem Cell Transplant, Beijing, P.R. China
| | - Yue Lu
- Hebei Yanda Lu Daopei Hospital and Beijing Lu Daopei Hospital, Beijing, Hebei, China
| | - Shaoyan Hu
- Children's Hospital of Soochow University, Soochow, China
| | - Chunfu Li
- Nanfang-Chunfu Children's Institute of Hematology and Oncology, Dongguan, China
| | - Yongmin Tang
- The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hongmei Wang
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jinsong Yan
- The Second Hospital of Dalian Medical University, Dalian, China
| | - Jing Chen
- Shanghai Children's Medical Center, Shanghai, China
| | - Sixi Liu
- Shenzhen Children's Hospital, Shenzhen, China
| | - Yuan Sun
- Beijing Jingdu Children's Hospital, Beijing, China
| | - Xuedong Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Lin
- Peking University People's Hospital, Peking University Institute of Haematology, National Clinical Research Center for Haematologic Disease, Collaborative Innovation Center of Haematology, Beijing Key Laboratory of Haematopoietic Stem Cell Transplant, Beijing, P.R. China
| | - Peihua Lu
- Hebei Yanda Lu Daopei Hospital and Beijing Lu Daopei Hospital, Beijing, Hebei, China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Haematology, National Clinical Research Center for Haematologic Disease, Collaborative Innovation Center of Haematology, Beijing Key Laboratory of Haematopoietic Stem Cell Transplant, Beijing, P.R. China.,Peking-Tsinghua Centre for Life Sciences, Beijing, China
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Wang X, Huang R, Zhang X, Zhang X. Current status and prospects of hematopoietic stem cell transplantation in China. Chin Med J (Engl) 2022; 135:1394-1403. [PMID: 35866344 PMCID: PMC9481431 DOI: 10.1097/cm9.0000000000002235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Hematopoietic stem cell transplantation (HSCT) is a highly effective and unique medical procedure for the treatment of most hematological malignancies. The first allogeneic transplantation was performed by E. Donnall Thomas in 1957. Since then, the field has evolved and expanded worldwide. The first successful allogenic HSCT (allo-HSCT) in China was conducted in 1981. Although the development of allo-HSCT in China lagged, China has since made considerable contributions to the process of HSCT worldwide, with more than 10,000 HSCTs performed annually. In particular, haploid HSCT (haplo-HSCT) technology represented in the Beijing Protocol has demonstrated similar efficacy to human leukocyte antigen-matched HSCT and has gradually become the pre-dominant choice for allo-HSCT in China. Currently, the number of haplo-HSCT procedures exceeds 5000 per year, and the Beijing Protocol has been greatly improved by implementing updated individualized strategies for controlling complications, relapse, and infection management. In addition, innovative haplo-HSCT technologies developed by different medical transplantation centers, such as Soochow, Zhejiang, Fujian, Chongqing, and Anhui, have emerged, providing inspiration for the refinement of global practice. This review will focus on the current activity in this field and highlight important trends that are vital in China's allo-HSCT process, examining the current viewpoint and future directions.
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Affiliation(s)
- Xiaoqi Wang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400037, China
| | - Ruihao Huang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400037, China
| | - Xiaohui Zhang
- Peking University People's Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400037, China
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