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Yesilipek MA, Uygun V, Kupesiz A, Karasu G, Ozturk G, Ertem M, Şaşmaz İ, Daloğlu H, Güler E, Hazar V, Fisgin T, Sezgin G, Kansoy S, Kuşkonmaz B, Akıncı B, Özbek N, İnce EÜ, Öztürkmen S, Küpesiz FT, Yalçın K, Anak S, Bozkurt C, Karakükçü M, Küpeli S, Albayrak D, Öniz H, Aksoylar S, Okur FV, Albayrak C, Yenigürbüz FD, Bozkaya İO, İleri T, Gürsel O, Karagün BŞ, Kintrup GT, Çelen S, Elli M, Aksoy BA, Yılmaz E, Tanyeli A, Akyol ŞT, Siviş ZÖ, Özek G, Uçkan D, Kartal İ, Atay D, Akyay A, Bilir ÖA, Çakmaklı HF, Kürekçi E, Malbora B, Akbayram S, Demir HA, Kılıç SÇ, Güneş AM, Zengin E, Özmen S, Antmen AB. Thalassemia-free and graft-versus-host-free survival: outcomes of hematopoietic stem cell transplantation for thalassemia major, Turkish experience. Bone Marrow Transplant 2022; 57:760-767. [PMID: 35210564 DOI: 10.1038/s41409-022-01613-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/07/2023]
Abstract
We report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for thalassemia major (TM) patients in Turkey on behalf of the Turkish Pediatric Stem Cell Transplantation Group. We retrospectively enrolled 1469 patients with TM who underwent their first HSCT between 1988 and 2020 in 25 pediatric centers in Turkey. The median follow-up duration and transplant ages were 62 months and 7 years, respectively; 113 patients had chronic graft versus host disease (cGVHD) and the cGVHD rate was 8.3% in surviving patients. Upon the last visit, 30 patients still had cGvHD (2.2%). The 5-year overall survival (OS), thalassemia-free survival (TFS) and thalassemia-GVHD-free survival (TGFS) rates were 92.3%, 82.1%, and 80.8%, respectively. cGVHD incidence was significantly lower in the mixed chimerism (MC) group compared to the complete chimerism (CC) group (p < 0.001). In survival analysis, OS, TFS, and TGFS rates were significantly higher for transplants after 2010. TFS and TGFS rates were better for patients under 7 years and at centers that had performed over 100 thalassemia transplants. Transplants from matched unrelated donors had significantly higher TFS rates. We recommend HSCT before 7 years old in thalassemia patients who have a matched donor for improved outcomes.
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Affiliation(s)
- M Akif Yesilipek
- Medicalpark Antalya Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Antalya, Turkey.
| | - Vedat Uygun
- Medicalpark Antalya Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Antalya, Turkey
- Istinye University School of Medicine Department of Pediatric Hematology and Oncology Unit, Istanbul, Turkey
| | - Alphan Kupesiz
- Akdeniz University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Antalya, Turkey
| | - Gulsun Karasu
- Medicalpark Göztepe Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Istanbul, Turkey
| | - Gulyuz Ozturk
- Acıbadem University School of Medicine, Altunizade Hospital, Istanbul, Turkey
| | - Mehmet Ertem
- Ankara University Faculty of Medicine, Division of Pediatric Hematology Oncology, Dikimevi, Ankara, Turkey
| | - İlgen Şaşmaz
- Acıbadem Adana Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Adana, Turkey
| | - Hayriye Daloğlu
- Medicalpark Antalya Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Antalya, Turkey
- Antalya Bilim University Faculty of Health Sciences, Antalya, Turkey
| | - Elif Güler
- Akdeniz University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Antalya, Turkey
| | - Volkan Hazar
- Medicalpark Göztepe Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Istanbul, Turkey
| | - Tunç Fisgin
- Altınbaş University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Istanbul, Turkey
| | - Gülay Sezgin
- Çukurova University School of Medicine Department of Pediatric Oncology and BMT Unit, Adana, Turkey
| | - Savaş Kansoy
- Ege University School of Medicine Division of Pediatric Hematology Oncology, İzmir, Turkey
| | - Barış Kuşkonmaz
- Hacettepe University Faculty of Medicine BMT Unit, Ankara, Turkey
| | - Burcu Akıncı
- Acıbadem University School of Medicine, Altunizade Hospital, Istanbul, Turkey
| | - Namık Özbek
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Ünal İnce
- Ankara University Faculty of Medicine, Division of Pediatric Hematology Oncology, Dikimevi, Ankara, Turkey
| | - Seda Öztürkmen
- Medicalpark Antalya Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Antalya, Turkey
| | - Funda Tayfun Küpesiz
- Akdeniz University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Antalya, Turkey
| | - Koray Yalçın
- Medicalpark Göztepe Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Istanbul, Turkey
- Bahcesehir University School of Medicine Departments of Pediatrics, Istanbul, Turkey
| | - Sema Anak
- Medipol University School of Medicine Division of Pediatric Hematology Oncology, Istanbul, Turkey
| | - Ceyhun Bozkurt
- Istinye University School of Medicine Department of Pediatric Hematology and Oncology Unit, Istanbul, Turkey
| | - Musa Karakükçü
- Erciyes University KANKA Pediatric BMT Center, Kayseri, Turkey
| | - Serhan Küpeli
- Çukurova University School of Medicine Department of Pediatric Oncology and BMT Unit, Adana, Turkey
| | - Davut Albayrak
- Medicalpark Samsun Hospital Pediatric BMT Unit, Samsun, Turkey
| | - Haldun Öniz
- University of Health Sciences, İzmir Tepecik Hospital, İzmir, Turkey
| | - Serap Aksoylar
- Ege University School of Medicine Division of Pediatric Hematology Oncology, İzmir, Turkey
| | - Fatma Visal Okur
- Hacettepe University Faculty of Medicine BMT Unit, Ankara, Turkey
| | - Canan Albayrak
- Ondokuzmayıs University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Samsun, Turkey
| | | | - İkbal Ok Bozkaya
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Talia İleri
- Ankara University Faculty of Medicine, Division of Pediatric Hematology Oncology, Dikimevi, Ankara, Turkey
| | - Orhan Gürsel
- University of Health Sciences, Division of Pediatric Hematology Oncology, Ankara, Turkey
| | - Barbaros Şahin Karagün
- Acıbadem Adana Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Adana, Turkey
| | - Gülen Tüysüz Kintrup
- Akdeniz University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Antalya, Turkey
| | - Suna Çelen
- Medicalpark Göztepe Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Istanbul, Turkey
- Bahcesehir University School of Medicine Departments of Pediatrics, Istanbul, Turkey
| | - Murat Elli
- Medipol University School of Medicine Division of Pediatric Hematology Oncology, Istanbul, Turkey
| | - Basak Adaklı Aksoy
- Altınbaş University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Istanbul, Turkey
| | - Ebru Yılmaz
- Erciyes University KANKA Pediatric BMT Center, Kayseri, Turkey
| | - Atila Tanyeli
- Çukurova University School of Medicine Department of Pediatric Oncology and BMT Unit, Adana, Turkey
| | | | - Zuhal Önder Siviş
- University of Health Sciences, İzmir Tepecik Hospital, İzmir, Turkey
| | - Gülcihan Özek
- Ege University School of Medicine Division of Pediatric Hematology Oncology, İzmir, Turkey
| | - Duygu Uçkan
- Hacettepe University Faculty of Medicine BMT Unit, Ankara, Turkey
| | - İbrahim Kartal
- Ondokuzmayıs University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Samsun, Turkey
| | - Didem Atay
- Acıbadem University School of Medicine, Altunizade Hospital, Istanbul, Turkey
| | - Arzu Akyay
- Inönü University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Malatya, Turkey
| | | | - Hasan Fatih Çakmaklı
- Ankara University Faculty of Medicine, Division of Pediatric Hematology Oncology, Dikimevi, Ankara, Turkey
| | - Emin Kürekçi
- University of Health Sciences, Division of Pediatric Hematology Oncology, Ankara, Turkey
| | - Barış Malbora
- İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital Pediatric BMT Unit, Istanbul, Turkey
| | - Sinan Akbayram
- Gaziantep University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Gaziantep, Turkey
| | - Hacı Ahmet Demir
- Memorial Ankara Hospital Pediatric Hematology and Oncology, Ankara, Turkey
| | - Suar Çakı Kılıç
- Ümraniye Education and Research Hospital, Department of Pediatric Bone Marrow Transplantation Unit, Istanbul, Turkey
| | - Adalet Meral Güneş
- Uludağ University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Bursa, Turkey
| | - Emine Zengin
- Kocaeli University School of Medicine Department of Pediatric Hematology and Oncology BMT Unit, Kocaeli, Turkey
| | - Salih Özmen
- Behçet Uz Children's Hospital Pediatric BMT Centre, İzmir, Turkey
| | - Ali Bülent Antmen
- Acıbadem Adana Hospital, Pediatric Hematology and Stem Cell Transplantation Unit, Adana, Turkey
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Huang C, Qu Y, Liu S, Nie S, Jiang H. Hematopoietic stem cell transplantation for thalassemia major using HLA fully-matched and mismatched donor grafts. Transl Pediatr 2021; 10:1552-1565. [PMID: 34295770 PMCID: PMC8261584 DOI: 10.21037/tp-20-415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Until now, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only effective method to cure Thalassemia major. However, it has not been determined whether similar results can be obtained with the same conditioning regimen for both fully-matched and mismatched donors grafts. We hypothesized that using modified NF-08-TM conditioning regimen could achieve similar results for both fully and mismatched donors grafts. METHODS This retrospective cohort study included patients with β-thalassemia major who underwent HSCT with modified NF-08-TM conditioning regimen at Guangzhou Women and Children's Medical Centre between January 2013 and January 2019. RESULTS Among the 257 patients (172 males) included in this study, 3 had two transplantations. Totally 193 and 67 had fully-matched and mismatched donors were examined, respectively. The median follow-up was 29 months; 6-year overall survival (OS), thalassemia-free survival (TFS), graft rejection (GR) and transplantation-related mortality (TRM) were 92.08%, 90.89%, 1.24% and 8.01%, respectively. Multivariate analysis showed that human leukocyte antigen (HLA) compatibility between patient and donor was not independently associated with OS, TFS, GR or TRM. Mismatched donor graft transplantation for β-thalassemia major is associated with similar survival outcomes and incidences of complications (except for acute GVHD) to fully-matched donor graft transplantation based on modified NF-08-TM conditioning regimen. CONCLUSIONS In conclusion, based on the modified NF-08-TM regimen, certain mismatched donor transplantations for thalassemia major patients could achieve similar results as fully-matched donor transplantations.
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Affiliation(s)
- Chuwen Huang
- Hematology and Oncology Department, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Yuhua Qu
- Hematology and Oncology Department, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Sha Liu
- Hematology and Oncology Department, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Shushan Nie
- Hematology and Oncology Department, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Hua Jiang
- Hematology and Oncology Department, Guangzhou Women and Children Medical Center, Guangzhou, China
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Mustafa M, Qatawneh M, Al Jazazi M, Jarrah O, Al Hazaimeh R, Oudat R, Al Tarawneh M, Al Majali R. Hematopoietic Stem Cell Transplantation in Thalassemia Patients: a Jordanian Single Centre Experience. Mater Sociomed 2020; 32:277-282. [PMID: 33628130 PMCID: PMC7879431 DOI: 10.5455/msm.2020.32.277-282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Beta thalassemia major is the commonest inherited hematological disorder worldwide which needs lifelong sufficient supportive management. Hematopoietic stem Cell transplantation (HSCT) is the only curative treatment available till now. Aim: To evaluate the outcome of children who underwent allogenic hematopoietic stem Cell transplantation as a curative approach for Thalassemia Major, treated at Queen Rania AL- Abdullah children Hospital (QRCH) Methods: A retrospective review of the medical files was conducted for all children (< 15 years) who had thalassemia major and received HSCT between January, 2010 and January, 2019. The following variables were studied for all patients: age , gender, Pesaro classifications, the count of infused raw bone marrow stem cell (CD34), engraftment time, outcome and complications. Results: A total of 34 children were transplanted for thalassemia major, at an average of 4 cases per year. All underwent allogenic raw bone marrow transplantation from matched related donors. Thirteen patients (38.2%) were males and twenty one (61.2%) were females. The age ranged between 2 and 15 years, with a median age of 6.5 years. According to Pesaro classification, 31 patients were class 2 (91.2%) and 3 patients were class 3 (8.8%) while no single case met the criteria for class 1 Pesaro classification. The median CD34 count was 3.5 million/Kg of recipient weight (range, 1.5*106-7*106 /kg). The median time for neutrophil engraftment was 15.5 days. At a median follow up of 5 years (range 1- 9.5), 33 patients were alive. One patient died before 100 days post transplantation due to grade IV acute gastrointestinal Graft Versus Host Disease (GVHD). Three patients had secondary graft failure (8.8%). Six patients (17.5 %) developed mild grade 1-2 skin GVHD while another patient developed hemorrhagic cystitis due to BK virus and cytomegalovirus (CMV) which reactivated simultaneously, and was successfully managed. Conclusion: The outlook for Thalassemia major has dramatically changed after HSCT, with a considerable success in Jordan and results comparable to international data.
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Affiliation(s)
- Maher Mustafa
- Department of Pediatric Hematology and Medical Oncology, Queen Rania Children Hospital, Royal Medical Services, Amman, Jordan
| | - Mousa Qatawneh
- Department of Pediatric Hematology and Medical Oncology, Queen Rania Children Hospital, Royal Medical Services, Amman, Jordan
| | - Mais Al Jazazi
- Department of Pediatric Hematology and Medical Oncology, Queen Rania Children Hospital, Royal Medical Services, Amman, Jordan
| | - Omaiema Jarrah
- Department of Pediatric Hematology and Medical Oncology, Queen Rania Children Hospital, Royal Medical Services, Amman, Jordan
| | - Ruba Al Hazaimeh
- Department of Pediatric Hematology and Medical Oncology, Queen Rania Children Hospital, Royal Medical Services, Amman, Jordan
| | - Raida Oudat
- Department of Hematopathology. Princess Iman Research and Laboratory Sciences Centre, Royal Medical Services, Amman, Jordan
| | - Moath Al Tarawneh
- Department of Pediatric Hematology and Medical Oncology, Queen Rania Children Hospital, Royal Medical Services, Amman, Jordan
| | - Rami Al Majali
- Department of Pediatric Hematology and Medical Oncology, Queen Rania Children Hospital, Royal Medical Services, Amman, Jordan
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