1
|
Rafii H, Volt F, Bierings M, Dalle JH, Ayas M, Rihani R, Faraci M, de Simone G, Sengeloev H, Passweg J, Cavazzana M, Costello R, Maertens J, Biffi A, Johansson JE, Montoro J, Guepin GR, Diaz MA, Sirvent A, Kenzey C, Rivera Franco MM, Cappelli B, Scigliuolo GM, Rocha V, Ruggeri A, Risitano A, De Latour RP, Gluckman E. Umbilical Cord Blood Transplantation for Fanconi Anemia With a Special Focus on Late Complications: a Study on Behalf of Eurocord and SAAWP-EBMT. Transplant Cell Ther 2024; 30:532.e1-532.e16. [PMID: 38452872 DOI: 10.1016/j.jtct.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
Hematopoietic cell transplantation (HCT) remains the sole available curative treatment for Fanconi anemia (FA), with particularly favorable outcomes reported after matched sibling donor (MSD) HCT. This study aimed to describe outcomes, with a special focus on late complications, of FA patients who underwent umbilical cord blood transplantation (UCBT). In this retrospective analysis of allogeneic UCBT for FA performed between 1988 and 2021 in European Society for Blood and Marrow Transplantation (EBMT)-affiliated centers, a total of 205 FA patients underwent UCBT (55 related and 150 unrelated) across 77 transplant centers. Indications for UCBT were bone marrow failure in 190 patients and acute leukemia/myelodysplasia in 15 patients. The median age at transplantation was 9 years (range, 1.2 to 43 years), with only 20 patients aged >18 years. Among the donor-recipient pairs, 56% (n = 116) had a 0 to 1/6 HLA mismatch. Limited-field radiotherapy was administered to 28% (n = 58) and 78% (n = 160) received a fludarabine (Flu)-based conditioning regimen. Serotherapy consisted of antithymocyte globulin (n = 159; 78%) or alemtuzumab (n = 12; 6%). The median follow-up was 10 years for related UCBT and 7 years for unrelated UCBT. Excellent outcomes were observed in the setting of related UCBT, including a 60-day cumulative incidence (CuI) of neutrophil recovery of 98.1% (95% confidence interval [CI], 93.9% to 100%), a 100-day CuI of grade II-IV acute graft-versus-host disease (GVHD) of 17.3% (95% CI, 9.5% to 31.6%), and a 5-year CuI of chronic GVHD (cGVHD) of 22.7% (95% CI, 13.3% to 38.7%; 13% extensive). Five-year overall survival (OS) was 88%. In multivariate analysis, none of the factors included in the model predicted a better OS. In unrelated UCBT, the 60-day CuI of neutrophil recovery was 78.7% (95% CI, 71.9% to 86.3%), the 100-day CuI of grade II-IV aGVHD was 31.4% (95% CI, 24.6% to 40.2%), and the 5-year CuI of cGVHD was 24.3% (95% CI, 17.8% to 32.2%; 12% extensive). Five-year OS was 44%. In multivariate analysis, negative recipient cytomegalovirus serology, Flu-based conditioning, age <9 years at UCBT, and 0 to 1/6 HLA mismatch were associated with improved OS. A total of 106 patients, including 5 with acute leukemia/myelodysplasia, survived for >2 years after UCBT. Nine of these patients developed subsequent neoplasms (SNs), including 1 donor-derived acute myelogenous leukemia and 8 solid tumors, at a median of 9.7 years (range, 2.3 to 21.8 years) post-UCBT (1 related and 8 unrelated UCBT). In a subset of 49 patients with available data, late nonmalignant complications affecting various organ systems were observed at a median of 8.7 years (range, 2.7 to 28.8 years) post-UCBT. UCB is a valid source of stem cells for transplantation in patients with FA, with the best results observed after related UCBT. After unrelated UCBT, improved survival was observed in patients who underwent transplantation at a younger age, with Flu-based conditioning, and with better HLA parity. The incidence of organ-specific complications and SNs was relatively low. The incidence of SNs, mostly squamous cell carcinoma, increases with time. Rigorous follow-up and lifelong screening are crucial in survivors of UCBT for FA.
Collapse
Affiliation(s)
- Hanadi Rafii
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Fernanda Volt
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Marc Bierings
- Princess Maxima Center, University Hospital for Children, Utrecht, Netherlands
| | - Jean-Hugues Dalle
- Pediatric Hematology and Immunology Department, Robert Debré Hospital, Université Paris Cité, APHP, Paris, France
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rawad Rihani
- Pediatric Blood, Marrow and Cellular Therapy Program, King Hussein Cancer Centre, Amman, Jordan
| | - Maura Faraci
- Hematopoetic Stem Cell Unit, Department of Hematology-Oncology, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Giuseppina de Simone
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Napoli, Italy
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit L 4043, National University Hospital, Copenhagen, Denmark
| | - Jakob Passweg
- Hematology Department, University Hospital of Basel, Basel, Switzerland
| | | | - Regis Costello
- Centre Hospitalier Universitaire La Conception, Marseille, France
| | - Johan Maertens
- Departement of Hematology,University Hospital Gasthuisberg, Leuven, Belgium
| | - Alessandra Biffi
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | | | | | | | | | - Anne Sirvent
- Pediatric Onco-Hematology Unit, CHU A de Villeneuve, Montpellier, France
| | - Chantal Kenzey
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Monica M Rivera Franco
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Barbara Cappelli
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Graziana Maria Scigliuolo
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hematology, Transfusion, and Cell Therapy Service and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clínicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
| | - Annalisa Ruggeri
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Risitano
- University of Naples, Avellino, Italy; AORN San Giuseppe Moscati, Avellino, Italy
| | - Regis Peffault De Latour
- Bone Marrow Transplant Unit, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eliane Gluckman
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco.
| |
Collapse
|
2
|
Giardino S, Eikema DJ, Piepenbroek B, Algeri M, Ayas M, Faraci M, Tbakhi A, Zecca M, Essa M, Neven B, Bertrand Y, Kharya G, Bykova T, Lawson S, Petrini M, Mohseny A, Rialland F, James B, Colita A, Fahd M, Cesaro S, Schulz A, Kleinschmidt K, Kałwak K, Corbacioglu S, Dufour C, Risitano A, de Latour RP. HLA-haploidentical stem cell transplantation in children with inherited bone marrow failure syndromes: A retrospective analysis on behalf of EBMT severe aplastic Anemia and pediatric diseases working parties. Am J Hematol 2024. [PMID: 38497679 DOI: 10.1002/ajh.27293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
Haploidentical stem cell transplantation (haplo-SCT) represents the main alternative for children with inherited bone marrow failure syndrome (I-BMF) lacking a matched donor. This retrospective study, conducted on behalf of the EBMT SAAWP and PDWP, aims to report the current outcomes of haplo-SCT in I-BMFs, comparing the different in vivo and ex vivo T-cell depletion approaches. One hundred and sixty-two I-BMF patients who underwent haplo-SCT (median age 7.4 years) have been registered. Fanconi Anemia was the most represented diagnosis (70.1%). Based on different T-cell depletion (TCD) approaches, four categories were identified: (1) TCRαβ+ /CD19+ -depletion (43.8%); (2) T-repleted with post-transplant Cyclophosphamide (PTCy, 34.0%); (3) In-vivo T-depletion with ATG/alemtuzumab (14.8%); (4) CD34+ positive selection (7.4%). The cumulative incidences (CI) of neutrophil and platelet engraftment were 84% and 76% respectively, while that of primary and secondary graft failure was 10% and 8% respectively. The 100-day CI of acute GvHD grade III-IV(95% CI) was 13%, while the 24-month CI of extensive chronic GvHD was 4%. After a median follow-up of 43.4 months, the 2-year overall survival(OS) and GvHD/Rejection-free Survival (GRFS) probabilities are 67% and 53%, respectively. The TCR CD3+ αβ+ /CD19+ depletion group showed a significantly lower incidence of both acute and chronic GvHD and higher OS (79%; p0.013) and GRFS (71%; p < .001), while no significant differences in outcomes have been observed by different diagnosis and conditioning regimens. This large retrospective study supports the safety and feasibility of haplo-SCT in I-BMF patients. TCRαβ+ /CD19+ depletion offers higher chances of patients' survival, with a significantly lower risk of severe a- and c-GvHD in I-BMFs compared to other platforms.
Collapse
Affiliation(s)
- Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Dirk-Jan Eikema
- Statistical Unit and Data Office, European Society for Blood and Marrow Transplantation (EBMT), Leiden, The Netherlands
| | | | - Mattia Algeri
- Department of Pediatric Haematology and Oncology & Stem and Gene Therapy, IRRCS Bambino Gesù Children's Hospital, Rome, Italy
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Department of Pediatric Hematology Oncology, Riyadh, Saudi Arabia
| | - Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mohammed Essa
- King Abdullah Specialist Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Bénédicte Neven
- Pediatric Immune-Hematology Unit, Necker Children Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Yves Bertrand
- Institut d'hémato oncologie Pédiatrique, Hospice Civil de Lyon, Paris, France
| | - Gaurav Kharya
- Centre for Bone Marrow Transplant & Cellular Therapy, Indraprastha Apollo Hospital, New Delhi, India
| | - Tatiana Bykova
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Sarah Lawson
- Department of Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - Mario Petrini
- Unit of Hematology, Santa Chiara University Hospital, University of Pisa, Pisa, Italy
| | - Alexander Mohseny
- Willem-Alexander Children's Hospital, Pediatric SCT program, Leiden University Medical Center, Leiden, The Netherlands
| | - Fanny Rialland
- Hôpital de la mère et l'enfant, Service d'hématologie pédiatrique, Nantes, France
| | - Beki James
- Leeds General Infirmary, Leeds Children's Hospital, Leeds, UK
| | - Anca Colita
- "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, Bucharest, Romania
| | - Mony Fahd
- Hematology and Immunology Pediatric Department, GHU APHP Nord-Université Paris Cité, Paris, France
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Ansgar Schulz
- Department of Pediatric Medicine, University Hospital Ulm, Eythstraße 24, Ulm, Germany
| | - Katharina Kleinschmidt
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Krzysztof Kałwak
- Supraregional Center of Pediatric Oncology "Cape of Hope", Wroclaw Medical University, Wroclaw, Poland
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Carlo Dufour
- Hematology Unit, Department of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Antonio Risitano
- Hematology and Hematopoietic Transplant Unit, Azienda Ospedaliera di Rilievo Nazionale "San Giuseppe Moscati" (A.O.R.N. Giuseppe Moscati), Avellino, Italy
| | - Régis Peffault de Latour
- Bone Marrow Transplant Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
3
|
Ayas M, Al-Hashim F, Siddiqui K, Al-Jefri A, Al-Ahmari A, Ghemlas I, Al-Saedi H, Al-Anazi A, Khan S, Qattan D, Al-Seraihi A. Hematopoietic stem cell transplantation in patients with Fanconi anemia: a report of late effects and psychosocial adjustment in life. Bone Marrow Transplant 2024; 59:141-143. [PMID: 37880411 DOI: 10.1038/s41409-023-02133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Fatima Al-Hashim
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen Al-Saedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif Al-Anazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Donya Qattan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Seraihi
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Khan S, AlSaif Z, Siddiqui K, AlSaedi H, Al-Ahmari A, Al-Jefri A, Ghemlas I, AlAnazi A, Ayas M. Is Mixed Chimerism Post-allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Acute Lymphoid Leukemia a Prognostic Factor for Relapse? Hematol Oncol Stem Cell Ther 2023; 17:72-78. [PMID: 37581467 DOI: 10.56875/2589-0646.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/11/2023] [Indexed: 08/16/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has been considered curative for children with high-risk acute leukemia (ALL), offering better survival. Short tandem repeat has been used as a marker of chimerism status after HSCT. The appearance of recipient cells >1% post-allogeneic stem cell transplant is defined as mixed chimerism (MC). Chimeric studies post-HSCT are dynamic. This study aimed to investigate the significance of recipient cells in post-HSCT pediatric ALL patients as a predictor of relapse of their primary disease. The rate of MC was 51.4% (19 out of 37 recipients). It was 48.6% (n = 18) during Day+100 and 12.9% (4 out of 31 recipients) during post-Day+100 follow-up until two years. No significant association was noted between MC and all grade overall acute graft-versus-host disease. A mortality rate of 35.1% (n = 13) and a median follow-up of 56.9 months (95% CI: 39.7-74.2) were observed for all but four (16.7%) of the survivors in remission. Regarding causes of death, transplant-related mortality was recorded in only 2 of 13 expired patients (15.4%); both succumbed to sepsis. No significant association was found between MC and primary causes of death. The cumulative probability of five-year overall survival and event-free survival was not found to be statistically significantly different for MC (≤1.0% vs. > 1.0%). In conclusion, our data did not show MC testing alone as an effective prognostic marker for detecting relapse; molecular and flow cytometric analyses should be considered in children with ALL post-HSCT for monitoring relapse.
Collapse
Affiliation(s)
- Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zainab AlSaif
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Hashmi S, Shaheen M, Adil S, Ahmed P, Ahmed S, Ben Abdeljelil N, Alabdulwahab A, Albeihany A, Aldaama S, Al-Khabori M, Alkindi S, Almohareb F, Alsaeed A, Alseraihy A, Alshemari S, Ayas M, Chaudhri N, Da'na W, Dennison D, ElQuessar A, Elhaddad A, Ibrahim A, Hashem H, Jastaniah W, Mawardi H, Nassar A, Satti T, Torjemane L, Tabbara K, El Solh H, Albeirouti B, Aljurf M. Unique aspects of Graft-versus-host-disease management in the Eastern Mediterranean region: Report from the Eastern Mediterranean blood and marrow transplantation group: Special report. Hematol Oncol Stem Cell Ther 2023; 16:303-306. [PMID: 32413418 DOI: 10.1016/j.hemonc.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shahrukh Hashmi
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marwan Shaheen
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | - Salman Adil
- Aga Khan University Hospital, Karachi, Pakistan
| | - Parvez Ahmed
- Quaid-e-Azam International Hospital, Islamabad, Pakistan
| | - Syed Ahmed
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | | | | | | | - Saad Aldaama
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | | | - Fahad Almohareb
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | - Ahmed Alsaeed
- King Abdulaziz Medical City-National Guard Hospital, Jeddah, Saudi Arabia
| | - Amal Alseraihy
- Pediatric Hematology & Oncology, KFSHRC, Riyadh, Saudi Arabia
| | | | - Mouhab Ayas
- Pediatric Hematology & Oncology, KFSHRC, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | | | | | - Asma ElQuessar
- Hematology, pediatric oncology, Ibn Rochd University Hospital, University of Hassan II, Casablanca, Morocco
| | | | - Ahmad Ibrahim
- Makassed Hospital, Lebanese University, Lebanon
- Middle East Hospital, Lebanese University, Lebanon
| | | | - Wasil Jastaniah
- King Abdulaziz Medical City-National Guard Hospital, Jeddah, Saudi Arabia
| | - Hani Mawardi
- King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Amr Nassar
- Prince Sultan Military Medical Center, Riyadh, Saudi Arabia
| | - Tariq Satti
- National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | | | | | - Hassan El Solh
- Pediatric Hematology & Oncology, KFSHRC, Riyadh, Saudi Arabia
| | - Bassim Albeirouti
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Mahmoud Aljurf
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| |
Collapse
|
6
|
Amao AT, Saleh M, Ayas M, Jafri R, Alqahtani S, AlAseri A, Sahabi M, Zulfiqar M, AlKofide A, Khan S, AlAhmari A, AlJefri A, Alsaedi HS, Alanazi A, Ghemlas I, Qattan D, AlShorman K, Ramadan L, Mohammed V. Implementing Web-Based Pre-Transplant Essential Data (TED) Collection Module for Centralized Access: Performance Improvement Project during COVID-19 Pandemic. Transplant Cell Ther 2023. [PMCID: PMC9899538 DOI: 10.1016/s2666-6367(23)00656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
7
|
Ramiz S, Elhaj O, Siddiqui K, Khan S, AlSaedi H, AlAnazi A, Al-Ahmari A, Al-Jefri A, Sahvan O, Ayas M, Ghemlas I. Clofarabine in Pediatric Acute Relapsed or Refractory Leukemia: Where Do We Stand on the Bridge to Hematopoietic Stem Cell Transplantation? J Hematol 2023; 12:16-26. [PMID: 36895294 PMCID: PMC9990710 DOI: 10.14740/jh1065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/12/2023] [Indexed: 02/26/2023] Open
Abstract
Background Despite pronounced improvement in overall survival (OS) in pediatric leukemia, a proportion of patients continue to suffer from lack of response or relapse, and the management of such patients is exceedingly difficult. Immunotherapy and engineered chimeric antigen receptor (CAR) T-cell therapy have shown promising results in the course of relapsed or refractory acute lymphoblastic leukemia (ALL). However, conventional chemotherapy continues to be utilized for re-induction purposes whether independently or in combination with immunotherapy. Methods Forty-three pediatric leukemia patients (age < 14 years at diagnosis) consecutively diagnosed at our institution and got treated with clofarabine based regimen at a single tertiary care hospital between January 2005 and December 2019 were enrolled in this study. ALL comprised of 30 (69.8%) patients of the cohort while the remaining 13 (30.2%) were with acute myeloid leukemia (AML). Results Post-clofarabine bone marrow (BM) was negative in 18 (45.0%) cases. Overall clofarabine failure rate was 58.1% (n = 25) with 60.0% (n = 18) in ALL and 53.8% (n = 7) in AML (P = 0.747). Eighteen (41.9%) patients eventually underwent hematopoietic stem cell transplantation (HSCT); 11 (61.1%) were from ALL group and remaining seven (38.9%) were AML (P = 0.332). Three- and 5-year OS of our patients was 37.7±7.6% and 32.7±7.3%. There was a trend of better OS for ALL patients compared to AML (40.9±9.3% vs. 15.4±10.0%, P = 0.492). Cumulative probability of 5-year OS was significantly better in transplanted patients (48.1±12.1% vs. 21.4±8.4%, P = 0.024). Conclusions Though almost 90% of our patients proceeded to HSCT with complete response post-clofarabine treatment, yet clofarabine-based regimens are associated with the significant burden of infectious complications and sepsis-related deaths.
Collapse
Affiliation(s)
- Sarah Ramiz
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Osama Elhaj
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Oudai Sahvan
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| |
Collapse
|
8
|
AlAnazi A, Nadeem A, Siddiqui K, AlAhmari A, Ghemlas I, AlJefri A, AlSaedi H, Khan S, Ayas M. Can the bone marrow harvest volume be reduced safely in hematopoietic stem cell transplantation with pediatric sibling donors? Blood Res 2023; 58:28-35. [PMID: 36632685 PMCID: PMC10063592 DOI: 10.5045/br.2023.2022167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Background Reduced harvest volumes in pediatric donors appear to have the potential to reduce donorassociated risks while maintaining engraftment in recipients; however, the allowable harvest volume reduction remains undefined. Methods We retrospectively analyzed the data pairs of 553 bone marrow (BM) harvests from pediatric (age at harvest <18 yr) sibling donors and clinical outcomes of 553 pediatric (age at infusion <14 yr) transplant-naïve recipients to assess the optimal BM harvest volume needed from pediatric donors to obtain the desired CD34+ cell count (≥3.0×106 per kg of recipient weight) and to study its impact on the clinical outcomes of transplantation in pediatric recipients. Results 506 (95.3%) donor-recipient pairs met the median CD34+ cell count of 6.4×106 per kg of recipient weight (range, 1.2-33.8×106) in donors younger than 5 years at harvest, 4.7×106 (range, 0.3-28.5×106) in donors aged 5-10 years and 2.1×106 (range, 0.3-11.3×106) in donors older than 10 years (P<0.001). Conclusion The infused CD34+ cell dose (×106 cells/kg of recipient weight) had no impact on GRFS; however, a CD34+ cell dose of >7×106 cells/kg of recipient weight did not improve hematopoietic recovery.
Collapse
Affiliation(s)
- Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amer Nadeem
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali AlAhmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah AlJefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Khan S, Siddiqui K, ElSolh H, AlJefri A, AlAhmari A, Ghemlas I, AlSaedi H, AlEnazi A, AlSeraihi A, Ayas M. Outcomes of blood and marrow transplantation in children less than 2-years of age: 23 years of experience at a single center. Int J Pediatr Adolesc Med 2022; 9:190-195. [PMID: 36937328 PMCID: PMC10019952 DOI: 10.1016/j.ijpam.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/28/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
Objectives Allogeneic hematopoietic cell transplantation (Allo-HCT) is a curative option for children with various malignant and non-malignant diseases. Most reports studied all age groups amongst children. Herein we analyzed our data in children transplanted at or less than 2-years of age. Patients and methods We reviewed medical charts of 618 patients who underwent 666 transplantation at our center between 1993 and 2015. There were 340 boys and 278 girls. Median age was 0.7 years (range 0.04-2). Stem cell source was bone marrow (BM) in 492 (73.9%), unrelated umbilical cord blood (UCB) in 161 (24.2%) followed by peripheral blood stem cell (PBSC) in 13 (2%) patients. Matched siblings were the most common donors (n = 356, 53.5%), followed by unrelated (n = 161, 24.2%) with haploidentical family member donors in 29 (4.4%) transplants. Disease groups were categorized as benign hematology (Thalassemia, Fanconi, Aplastic anemia etc.), benign neoplasm (Langerhans cell histiocytosis, Hemophagocytic Lymphohistiocytosis etc.), non-neoplasms (metabolic disorders, immunodeficiency disorders etc.) and Leukemia/lymphomas (myeloid and lymphoid malignancies etc.). Results Cumulative incidence of acute GvHD (I-IV) was 31.5% (n = 210) and grade III-IV GvHD was 8.7% (n = 58). At median follow-up of 115.1 months, the cumulative probability of overall survival (OS) at 5 years was 70.0% ± 1.9%. Our mortality rate was 31.2% (n = 193). The five-year OS was significantly better in patients transplanted for benign hematological disorders (P = .001). Patients transplanted using BM/PBSC as source of stem cells fared significantly better compared to those in which CB was used (P<.001). Post-transplant graft failure remains the leading cause requiring further transplants in this age group. In conclusion, the cumulative probability of OS at 5 years was about 70.0% for all with an OS of 61% in our haploidentical recipients. Conclusion Analyzing our institutional data over time has enabled us to develop tentative strategies to minimize transplant related toxicities in very young children who are candidates for allo-HCT.
Collapse
|
10
|
Al-Ghemlas I, Al-Daama S, Aqueel H, Siddiqui K, El-Solh H, Omer H, AlRajeh L, Al-Seraihy A, Alahmari A, AlSaedi H, AlAnazi A, Ayas M. Outcome of pediatric chronic myeloid leukemia with management focusing on the monitoring of BCR-ABL fusion gene transcript levels. Int J Pediatr Adolesc Med 2022; 9:160-164. [PMID: 36090130 PMCID: PMC9441250 DOI: 10.1016/j.ijpam.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/15/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022]
Abstract
Background and objective Clinical, laboratory and outcome data were reviewed for pediatric patients who were diagnosed with chronic myeloid leukemia (CML) and managed at two tertiary care hospitals in Saudi Arabia, between January 2011 and December 2017 to assess the response to tyrosine kinase inhibitors (TKI) focusing on the monitoring of BCR-ABL fusion gene transcript levels and to look at the overall outcome. Methods CML patients were identified based on the cytogenetic and molecular results. Results Twelve pediatric patients diagnosed with CML at a median age of 8.4 year; treated with TKI as first-line therapy, 11 (91.7%) patients were started with imatinib (first-generation TKI), while one received dasatinib (second-generation TKI) due to his three-way Philadelphia chromosome sensitivity. Eight patients (72.7%) starting on imatinib were switched to dasatinib (six patients due to drug resistance, and two patients due to intolerance of Imatinib) and two patients (25%) of whom had already achieved major molecular response (MMR) on Imatinib. Response rate to imatinib in terms of achieving MMR as first-line therapy was achieved in five out of 11 patients (45.5%) and only three of them continued to maintain their MMR. Six out of eight patients who were switched to dasatinib achieved MMR. Two patients underwent hematopoietic stem cell transplant (SCT): one due to blast crisis and one due to the side effects of TKI. With a median follow-up time of 78 months (range, 40.5–108), all of our patients were alive at last update. Conclusion We report an excellent outcome with an overall survival (OS) of 100% at 5-year and disease-free survival (DFS) of 91.7% (8.0%). All our patients achieved MMR and only one patient had loss of MMR on follow-up. Eight patients (66.7%) achieved complete molecular response (CMR).
Collapse
Affiliation(s)
- Ibrahim Al-Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
- Corresponding author. Department of Pediatric Hematology/Oncology, MBC 53, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia.
| | - Saad Al-Daama
- Department of Pediatric Hematology/Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hawazin Aqueel
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Hassan El-Solh
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Hala Omer
- Department of Pediatric Hematology/Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Loloah AlRajeh
- Department of Pediatric Hematology/Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amal Al-Seraihy
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ali Alahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| |
Collapse
|
11
|
AlSaedi H, Mohammed R, Siddiqui K, Al-Ahmari A, AlSaud B, Almousa H, Al-Jefri A, Ghemlas I, AlAnazi A, Al-Seraihy A, El-Solh H, Ayas M. HLA-haploidentical donor transplants with post-transplant cyclophosphamide in children with primary immune deficiency disorders. Bone Marrow Transplant 2022; 57:668-670. [PMID: 35121808 DOI: 10.1038/s41409-022-01589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Reem Mohammed
- Department of Pediatrics King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bandar AlSaud
- Department of Pediatrics King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hamoud Almousa
- Department of Pediatrics King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Seraihy
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hassan El-Solh
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Al-Jefri A, Siddiqui K, Al-Oraibi A, Al-Seraihy A, Al Ahmari A, Ghemlas I, Al Anazi A, Al Saedi H, Ayas M. Hematopoietic Stem Cell Transplantation Stabilizes Cerebral Vasculopathy in High-Risk Pediatric Sickle Cell Disease Patients: Evidence From a Referral Transplant Center. J Hematol 2022; 11:8-14. [PMID: 35356638 PMCID: PMC8929199 DOI: 10.14740/jh949] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Corresponding Author: Abdullah Al-Jefri, Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia.
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amira Al-Oraibi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Seraihy
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif Al Anazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen Al Saedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
13
|
Khan S, AlSayyad K, Siddiqui K, AlAnazi A, AlSeraihy A, AlAhmari A, ElSolh H, Ghemlas I, AlSaedi H, AlJefri A, Ali A, AlFawaz I, AlKofide A, Ayas M. Pediatric high risk neuroblastoma with autologous stem cell transplant - 20 years of experience. Int J Pediatr Adolesc Med 2021; 8:253-257. [PMID: 34401451 PMCID: PMC8356102 DOI: 10.1016/j.ijpam.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Neuroblastoma is the most common extracranial solid tumor found in pediatric patients. High-risk neuroblastoma (HR-NBL) can be characterized by metastasis, age, and other tumor characteristics that result in an adverse outlook for this patient cohort. The standard of care includes induction chemotherapy, surgery, followed by stem cell autologous transplant (ASCT), and later, antidisialoganglioside (anti-GD2) antibodies. In this study, we provide the survival and toxicity data of our HR-NBL patients treated with a single ASCT. METHODS We retrospectively analyzed pediatric HR-NBL patients treated with single ASCT after a carboplatin, etoposide, and melphalan (CEM) regimen in our institution between January 1993 and December 2014. RESULTS There were 99 evaluable patients with male predominance. The median age at diagnosis was 3 years. Most of our HR-NBL patients were stage 4 (88%). All patients received ASCT. Peripheral blood was the graft source in 58% of the patients. Time for hematological count recovery with bone marrow as a graft source was prolonged but not statistically significant when compared with PBSCs. Of all the patients, 58% received radiation therapy to residual disease. Overt secondary leukemia was not seen in any of these patients. Three-year overall survival (OS) was 68.5% ± 5.2% and the 3-year event-free survival (EFS) was (48.3% ± 5.2%). CONCLUSION Our HR-NBL patients tolerated high-dose chemotherapy well followed by single autologous stem cell transplant. Tandem transplant is a feasible option in our patient cohort. Apart from secondary solid tumors, there were no long-term complications seen.
Collapse
|
14
|
Ahmari AA, Alsmadi O, Sheereen A, Elamin T, Jabr A, El-Baik L, Alhissi S, Saud BA, Al-Awwami M, Fawaz IA, Ayas M, Siddiqui K, Hawwari A. Genetic and clinical characteristics of pediatric patients with familial hemophagocytic lymphohistiocytosis. Blood Res 2021; 56:86-101. [PMID: 34083498 PMCID: PMC8246041 DOI: 10.5045/br.2021.2020308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/02/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background Our study was designed to investigate the frequencies and distributions of familial hemophagocytic lymphohistiocytosis (FHL) associated genes in Saudi patients. Methods FHL associated gene screening was performed on 87 Saudi patients who were diagnosed with hemophagocytic lymphohistiocytosis (HLH) between 1995 and 2014. The clinical and biochemical profiles were also retrospectively captured and analyzed. Results Homozygous mutations and mono-allelic variants were identified in 66 (75.9%) and 3 (3.5%) of the study participants, respectively. STXBP2 was the most frequently mutated gene (36% of patients) and mutations in STXBP2 and STX11 accounted for 58% of all FHL cases and demonstrated a specific geographical pattern. Patients in the FHL group presented at a significantly younger age than those belonging to the unknown-genetics group (median, 3.9 vs. 9.4 mo; P=0.005). The presenting clinical features were similar among the various genetic groups and the 5-year overall survival (OS) was 55.4% with a 5.6 year median follow-up. Patients with PRF1 mutations had a significantly poorer 5-year OS (21.4%, P=0.008) and patients undergoing hematopoietic stem cell transplant (72.4%) had a significantly better 5-year OS (66.5% vs. 0%, P=0.001). Conclusion Our study revealed the predominance of the STXBP2 mutations in Saudi patients with FHL. A genetic diagnosis was possible in 80% of the cohort and our data showed improved survival in FHL patients who underwent hematopoietic stem cell transplant.
Collapse
Affiliation(s)
- Ali Al Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia.,College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Osama Alsmadi
- Section of Immunogenetics, Department of Genetics, Research Center, King Faisal Specialist Hospital and Research Center, Saudi Arabia.,Cell Therapy, Applied Genomics, King Hussein Cancer Center, Amman, Jordan
| | - Atia Sheereen
- Section of Immunogenetics, Department of Genetics, Research Center, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Tanziel Elamin
- Section of Immunogenetics, Department of Genetics, Research Center, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Amal Jabr
- Section of Immunogenetics, Department of Genetics, Research Center, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Lina El-Baik
- Section of Immunogenetics, Department of Genetics, Research Center, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Safa Alhissi
- Section of Immunogenetics, Department of Genetics, Research Center, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Bandar Al Saud
- Department of Pediatric Allergy/Immunology, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Moheeb Al-Awwami
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Ibrahim Al Fawaz
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia.,College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia.,College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia
| | - Abbas Hawwari
- Section of Immunogenetics, Department of Genetics, Research Center, King Faisal Specialist Hospital and Research Center, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City Hospital, Al-Ahsa, Saudi Arabia
| |
Collapse
|
15
|
Zubicaray J, Pagliara D, Sevilla J, Eikema D, Bosman P, Ayas M, Zecca M, Yesilipek A, Kansoy S, Renard C, Dalle JH, Campos A, Faraci M, Kupesiz A, Smiers FJW, Velardi A, Abecasis M, Corti P, Fagioli F, González Muñiz S, Kriván G, Dufour C, Risitano A, Corbacioglu S, Peffault de Latour R. Haplo-identical or mismatched unrelated donor hematopoietic cell transplantation for Fanconi anemia: Results from the Severe Aplastic Anemia Working Party of the EBMT. Am J Hematol 2021; 96:571-579. [PMID: 33606297 DOI: 10.1002/ajh.26135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/20/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the only curative option for bone marrow failure or hematopoietic malignant diseases for Fanconi anemia (FA) patients. Although results have improved over the last decades, reaching more than 90% survival when a human leukocyte antigen (HLA)-identical donor is available, alternative HCT donors are still less reported. We compared HCT outcomes using HLA-mismatched unrelated donors (MMUD; n = 123) or haplo-identical donors (HDs), either using only in vivo T cell depletion (n = 33) or T cells depleted in vivo with some type of graft manipulation ex vivo (n = 59) performed for FA between 2000 and 2018. Overall survival (OS) by 24 months was 62% (53-71%) for MMUD, versus 80% (66-95%) for HDs with only in vivo T cell depletion and 60% (47-73%) for HDs with in vivo and ex vivo T cell depletion (p = .22). Event-free survival (EFS) was better for HD-transplanted FA patients with only in vivo T cell depletion 86% (73-99%) than for those transplanted from a MMUD 58% (48-68%) or those with graft manipulation 56% (42-69%) (p = .046). Grade II-IV acute graft-versus-host disease (GVHD) was 41% (MMUD) versus 40% (HDs with no graft manipulation) versus 17% (HDs with T cell depleted graft), (p = .005). No differences were found for the other transplant related outcomes. These data suggest that HDs might be considered as an alternative option for FA patients with better EFS using unmanipulated grafts.
Collapse
Affiliation(s)
- Josune Zubicaray
- Niño Jesus Children's Hospital, Fundación para la investigación del HIUNJ Madrid Spain
| | | | - Julian Sevilla
- Niño Jesus Children's Hospital, Fundación para la investigación del HIUNJ Madrid Spain
| | | | - Paul Bosman
- EBMT Data Office Leiden Leiden The Netherlands
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Savas Kansoy
- Ege University Pediatric BMT Centre Izmir Turkey
| | - Cécile Renard
- Institut d'Hematologie et d'Oncologie Pediatrique, Hospices Civils de Lyon Lyon France
| | - Jean H. Dalle
- Hemato‐Immunology Department Robert‐Debre Hospital, GHU Nord‐Université de Paris Paris France
| | | | | | | | - Frans J. W. Smiers
- Department of Pediatrics Leiden University Medical Center Leiden The Netherlands
| | | | | | - Paola Corti
- Clinica Pediatrica, Fondazione MBBM Universita degli Studi di Milano Bicocca Monza Italy
| | - Franca Fagioli
- Pediatric Onco‐Hematology and Stem Cell Transplantation Division Regina Margherita Children's Hospital, University of Turin Turin Italy
| | | | - Gergely Kriván
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation Central Hospital of Southern Pest – National Institute of Hematology and Infectious Diseases Budapest Hungary
| | | | - Antonio Risitano
- AORN San Giuseppe Moscati, Hematology and Hematopoietic Stem Cell Transplantation Unit Avellino Italy
- Federico II University of Naples Naples Italy
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation University of Regensburg Regensburg Germany
| | - Régis Peffault de Latour
- French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria Saint Louis Hospital and University Paris Diderot Paris France
| |
Collapse
|
16
|
Alhussain A, Alkhayal Z, Ayas M, Abed H. Prevalence and risk factors of oral mucositis in paediatric patients undergoing haematopoietic stem cell transplantation. Oral Dis 2021; 28:657-669. [PMID: 33453145 PMCID: PMC9291549 DOI: 10.1111/odi.13777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/19/2020] [Accepted: 01/03/2021] [Indexed: 11/26/2022]
Abstract
Background A complete understanding of oral mucositis (OM) is crucial to develop appropriate interventions to aid in the successful overall health outcome of paediatric patients undergoing haematopoietic stem cell transplantation (HSCT). Aims This study aimed at determining the prevalence and severity of OM and at identifying the predictive factors that might aggravate OM at one‐week, two‐week and three‐week post‐HSCT. Methods This retrospective, hospital‐based study reviewed the medical records of 170 paediatric patients, summarising the patients’ characteristics using descriptive statistics. Binary logistic regression was used to identify factors associated with the development of OM. Results At one‐week post‐HSCT, 41% of 140 patients (n = 49) had developed OM, this was reduced at two‐week (n = 36, 33%) and three‐week (n = 13, 19%) post‐HSCT. Univariate logistic regression revealed that patients with cancer (OR = 0.16, 95% CI = 0.05–0.54; p‐value = .003) had a significantly lower prevalence of OM. Younger patients with an average age of 7.9 years old (OR = 0.85, 95% CI = 0.75–0.97; p‐value = 0.013) and the presence of GvHD (OR = 2.37, 95% CI = 1.03–5.45, p‐value = 0.042) were significantly related to a higher prevalence of OM. Multivariable logistic regression confirmed that the risk of OM is lower in patients with cancer compared to those with immunodeficiency syndromes or hereditary blood diseases (OR = 0.18, 95% CI = 0.04–0.77; p‐value = .021). Conclusions This study identified a significantly lower prevalence of OM in patients with cancer compared to other conditions and that young recipients and those who developed GvHD were more likely to have OM.
Collapse
Affiliation(s)
- Abdulmalik Alhussain
- North of Riyadh Dental Centre, Central Second Health Cluster, Riyadh, Saudi Arabia
| | - Zikra Alkhayal
- Department of Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Paediatric Haematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hassan Abed
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| |
Collapse
|
17
|
Al-Kofide A, Alkatan H, Khafaga Y, Siddiqui K, Jafri R, Ayas M, AlMesfer S. Post-enucleation retinoblastoma: Outcome analysis and evaluation of prognostic features. J Nat Sci Med 2021. [DOI: 10.4103/jnsm.jnsm_58_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
18
|
AlFawaz I, Ahmed B, Ali A, Ayas M, AlKofide A, Habib Z, Siddiqui K. Experience of treating pediatric hepatoblastoma at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia - Timely surgical intervention playing a key role. Int J Pediatr Adolesc Med 2020; 8:39-43. [PMID: 33718576 PMCID: PMC7922831 DOI: 10.1016/j.ijpam.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/10/2020] [Accepted: 11/05/2020] [Indexed: 12/04/2022]
Abstract
Background Many studies have demonstrated that outcome in patients with hepatoblastoma is determined by tumor resectability and the presence or absence of metastatic disease. Purpose To evaluate and disseminate information on diagnosis, treatment, and outcome of hepatoblastoma patients at a tertiary care hospital in Saudi Arabia. Patients and methods Twenty-four pediatric patients with hepatoblastoma were treated at our institution between January 2005 and December 2012. The majority of our patients were stage III and above, while one-third of them presented with metastatic disease. Four (16.7%) had vascular invasion. Two-thirds of our patients (n = 16, 66.7%) had alpha-fetoprotein (AFP) level above 100,000 ng/mL. Twenty-one patients underwent surgery; two had upfront surgery before getting any chemotherapy, and 15 had surgery on schedule after pre-operative chemotherapy. Four patients had delayed surgery as the tumor was not resectable and received extra cycles of chemotherapy. Chemotherapy regimens used were based on SIOPEL study protocols until 2011 and Children’s Oncology Group (COG) protocol from 2012 onwards. Relapse, progressive disease, or death from any cause were defined as events. Results Five-year overall survival (OS) of the cohort over a median follow-up time of 56.1 months was 70.6% ± 9.4% with seven (29.2%) events of mortality. No significant difference was found for age at diagnosis (less than 2 years vs. more), stage of disease, AFP levels (less than 100,000 vs. more), vascular invasion, or presence of metastatic disease at presentation in terms of OS. However, children receiving upfront or scheduled as-per-protocol surgery fared better than those who had delayed surgery (as the tumor was not resectable and they received extra cycles of chemotherapy) or did not undergo any surgery (P-Value .001). Conclusion Favorable survival outcome could be achieved with complete tumor excision and adjuvant chemotherapy. Inability to perform surgical excision was the single most important predictor of mortality in our patients.
Collapse
Affiliation(s)
- Ibrahim AlFawaz
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Basheer Ahmed
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Afshan Ali
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amani AlKofide
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zakaria Habib
- Department of Surgery King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
19
|
Alsultan A, Aljefri A, Ayas M, Alharbi M, Alkhayat N, Al-Anzi F, Yassin F, Alkasim F, Alharbi Q, Abdullah S, Abrar M, Jastaniah W. Travel burden and geographic access to health care among children with cancer in Saudi Arabia. East Mediterr Health J 2020; 26:1355-1362. [PMID: 33226103 DOI: 10.26719/emhj.20.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/13/2019] [Indexed: 11/09/2022]
Abstract
Background Travel burden has a substantial psychosocial impact and financial strain on childhood cancer patients and their families. Aims To study the geographic distribution of childhood cancer and assess the travel burden for care in Saudi Arabia. Methods This was a cross-sectional multi-institutional study that enrolled 1657 children with cancer who were diagnosed between 2011 and 2014. Cancer type/stage, city/region of residence, and city/region of treating centre were recorded. Travel burden was measured based on a 1-way distance in kilometres from the city centre to the treatment institution. This study was supported by Sanad Children's Cancer Support Association. Results Diagnosis was leukaemia (45.2%), non-CNS solid tumours (30.2%), lymphoma (12.3%), CNS tumours (11.8%) and histiocytosis (0.5%). Childhood cancer centres were in the same city as where the patients lived in 652 (39.3%) cases, same region but different city in 308 (18.6%), different regions in 613 (37%), and not known in 84 (5.1%). The mean 1-way travel distance for patients who lived in different regions was 790 (range, 116-1542) km. A total of 536 (32%) patients lived ≥ 400 km and 216 (13%) > 1000 km from the treatment centre. Among 642 patients with acute lymphoblastic leukaemia who required 2-3 years of therapy, 197 (31%) lived ≥ 400 km and 94 (15%) >1000 km from the treatment centre. Conclusions Nearly two thirds of patients with childhood cancer lived in different cities than the treatment centres, including one third of patients who lived ≥ 400 km away. There is a need to develop strategies to improve access to childhood cancer care.
Collapse
Affiliation(s)
- Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
| | - Abdullah Aljefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Musa Alharbi
- Department of Pediatric Hematology/Oncology, Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Alkhayat
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faisal Al-Anzi
- Prince Faisal Bin Bandar Cancer Center, Qassim, Saudi Arabia
| | - Fawwaz Yassin
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Fawaz Alkasim
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Qasim Alharbi
- Department of Pediatric Hematology/Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shaker Abdullah
- Department of Oncology, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Abrar
- Department of Oncology, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Wasil Jastaniah
- Department of Oncology, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia.,Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| |
Collapse
|
20
|
Shaheen M, Almohareb F, Aljohani N, Ayas M, Chaudhri N, Abosoudah I, Alotaibi S, Alshahrani M, Alsharif F, Akhtar S, Alhumaidan H, Rasheed W, Alfraih F, Al-Anazi K, Alhashmi H, Al-Daama S, Hanbali A, Alsaleh K, Alzahrani H, Ibrahim K, Alawwami M, Albeirouti B, Albeihany A, Alabdulwahab A, Motabi I, Zaidi SZA, Ahmed SO, Aljefri A, Hussain F, Alahmari A, Hashmi S, Elsolh H, Alseraihy A, Aljurf M. Hematopoietic stem cell transplantation in Saudi Arabia between 1984 and 2016: Experience from four leading tertiary care hematopoietic stem cell transplantation centers. Hematol Oncol Stem Cell Ther 2020; 14:169-178. [PMID: 32888899 DOI: 10.1016/j.hemonc.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022] Open
Abstract
Saudi Arabia is the largest of the Arabian Gulf countries with a total population of 33.41 million as of 2017. This report summarizes the experience from four leading tertiary care hematopoietic stem cell transplantation (HSCT) centers in Saudi Arabia representing more than 90% of all HSCTs performed in the country. Between 1984 and 2016, a total of 6,184 HSCTs were performed. Of these, 3,586 HSCTs were performed in adults and 2,598 HSCTs were performed in pediatric patients. Malignancy was the main indication for transplantation (47%). While most transplants were performed from an identical sibling donor, HSCTs from cord blood, unrelated and, more recently, haploidentical donors have also been performed. Relative shortage of HSCT bed capacity is perceived to be a limiting factor in Saudi Arabia. Lately, more HSCT centers are emerging with rapid growth, which may significantly improve the access to HSCT in the country in the near future.
Collapse
Affiliation(s)
- Marwan Shaheen
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia.
| | - Fahad Almohareb
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Naif Aljohani
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Jeddah, Saudi Arabia
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Ibraheem Abosoudah
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Jeddah, Saudi Arabia
| | | | | | - Fahad Alsharif
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Saad Akhtar
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Hind Alhumaidan
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Feras Alfraih
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | | | - Hani Alhashmi
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Saad Al-Daama
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amr Hanbali
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- King Khalid University Hospital, Riyadh, Saudi Arabia; Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hazzaa Alzahrani
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Khalid Ibrahim
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Moheeb Alawwami
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Bassim Albeirouti
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Jeddah, Saudi Arabia
| | | | | | | | | | - Syed O Ahmed
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Abdullah Aljefri
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Fazal Hussain
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Ali Alahmari
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Shahrukh Hashmi
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Hassan Elsolh
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Amal Alseraihy
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| |
Collapse
|
21
|
Alsultan A, Essa M, Aljefri A, Ayas M, Alharbi M, Alkhayat N, Al-Anzi F, Yassin F, Alkasim F, Alharbi Q, Abdullah S, Jastaniah W. Frequency of pathogenic/likely pathogenic germline variants in cancer-related genes among children with acute leukemia in Saudi Arabia. Pediatr Blood Cancer 2020; 67:e28340. [PMID: 32359129 DOI: 10.1002/pbc.28340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The frequency of pathogenic/likely pathogenic (P/LP) germline mutations in cancer-related genes among children with cancer in highly consanguineous populations is not well studied. METHODS Whole-exome sequencing of germline DNA was performed in 60 children with acute leukemia. We used the St. Jude Pediatric Cancer Variant Pathogenicity Information Exchange (PeCanPIE) data portal for the classification of germline variants by the St. Jude Medal Ceremony pipeline. RESULTS Fifty-seven patients had acute lymphoblastic leukemia (ALL) and three patients had acute myeloid leukemia. Parental consanguinity was present in 27 (45%) patients. All patients were of Arab ancestry. Three patients (5%) had a history of cancer in their siblings. Five patients (8.3%) had P/LP germline mutations in cancer-related genes. Three patients with B-ALL had heterozygous pathogenic mutations in TP53, BRCA1, and BRCA2; one patient with B-ALL had homozygous pathogenic mutation in PMS2; and one patient with T-ALL had LP homozygous mutation in AK2 that was associated with reticular dysgenesis. Among patients who had history of parental consanguinity, three (11%) had P/LP germline mutations compared with two (8%) in the absence of parental consanguinity. Fourteen (23%) patients had gold medal variants in cancer-related genes, 13 were heterozygous, and one was homozygous. Silver medal variants were present in 35 (58%) patients; all were heterozygous except one homozygous. CONCLUSIONS Children with acute leukemia in Saudi Arabia had low frequency of P/LP mutations in cancer-related genes despite the high rate of consanguinity. Larger studies using whole-genome sequencing are needed to further explore the heritability of childhood leukemia.
Collapse
Affiliation(s)
- Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Essa
- Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia.,College of Medicine, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Aljefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Musa Alharbi
- Department of Pediatric Hematology/Oncology, Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Alkhayat
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faisal Al-Anzi
- Prince Faisal Bin Bandar Cancer Center, Qassim, Saudi Arabia
| | - Fawwaz Yassin
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Qasim Alharbi
- Department of Pediatric Hematology/Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shaker Abdullah
- Department of Oncology, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Wasil Jastaniah
- Department of Oncology, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia.,Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| |
Collapse
|
22
|
Giardino S, Latour RP, Aljurf M, Eikema D, Bosman P, Bertrand Y, Tbakhi A, Holter W, Bornhäuser M, Rössig C, Burkhardt B, Zecca M, Afanasyev B, Michel G, Ganser A, Alseraihy A, Ayas M, Uckan‐Cetinkaya D, Bruno B, Patrick K, Bader P, Itälä‐Remes M, Rocha V, Jubert C, Diaz MA, Shaw PJ, Junior LGD, Locatelli F, Kröger N, Faraci M, Pierri F, Lanino E, Miano M, Risitano A, Robin M, Dufour C. Outcome of patients with Fanconi anemia developing myelodysplasia and acute leukemia who received allogeneic hematopoietic stem cell transplantation: A retrospective analysis on behalf of EBMT group. Am J Hematol 2020; 95:809-816. [PMID: 32267023 DOI: 10.1002/ajh.25810] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is curative for bone marrow failure in patients with Fanconi anemia (FA), but the presence of a malignant transformation is associated with a poor prognosis and the management of these patients is still challenging. We analyzed outcome of 74 FA patients with a diagnosis of myelodysplastic syndrome (n = 35), acute leukemia (n = 35) or with cytogenetic abnormalities (n = 4), who underwent allo-HSCT from 1999 to 2016 in EBMT network. Type of diagnosis, pre-HSCT cytoreductive therapies and related toxicities, disease status pre-HSCT, donor type, and conditioning regimen were considered as main variables potentially influencing outcome. The 5-year OS and EFS were 42% (30-53%) and 39% (27-51%), respectively. Patients transplanted in CR showed better OS compared with those transplanted in presence of an active malignant disease (OS:71%[48-95] vs 37% [24-50],P = .04), while none of the other variables considered had an impact. Twenty-two patients received pre-HSCT cytoreduction and 9/22 showed a grade 3-4 toxicity, without any lethal event or negative influence on survival after HSCT(OS:toxicity pre-HSCT 48% [20-75%] vs no-toxicity 51% [25-78%],P = .98). The cumulative incidence of day-100 grade II-IV a-GvHD and of 5-year c-GvHD were 38% (26-50%) and 40% (28-52%). Non-relapse-related mortality and incidence of relapse at 5-years were 40% (29-52%) and 21% (11-30%) respectively, without any significant impact of the tested variables. Causes of death were transplant-related events in most patients (34 out of the 42 deaths, 81%). This analysis confirms the poor outcome of transformed FA patients and identifies the importance of achieving CR pre-HSCT, suggesting that, in a newly diagnosed transformed FA patient, a cytoreductive approach pre-HSCT should be considered if a donor have been secured.
Collapse
Affiliation(s)
- Stefano Giardino
- Hematopoietic stem cell transplantation UnitIstituto Giannina Gaslini Genoa Italy
| | - Regis P. Latour
- French reference center for aplastic anemia and PNH;Saint‐Louis HospitalUniversité de Paris Paris France
| | - Mahmoud Aljurf
- King Faisal Hospital and Research Centre Riyadh Saudi Arabia
| | | | | | | | | | | | | | - Claudia Rössig
- Pediatric Hematology and OncologyUniversity Children´s Hospital Muenster Muenster Germany
| | - Birgit Burkhardt
- Pediatric Hematology and OncologyUniversity Children´s Hospital Muenster Muenster Germany
| | - Marco Zecca
- Fondazione IRCSS Policlinico San Matteo Pavia Italy
| | | | | | | | - Amal Alseraihy
- King Faisal Hospital and Research Centre Riyadh Saudi Arabia
| | - Mouhab Ayas
- King Faisal Hospital and Research Centre Riyadh Saudi Arabia
| | | | | | | | - Peter Bader
- Immunologie und IntensivmedizinKlinikum der Johann‐Wolfgang Goethe Universität, Klinik für Kinder‐und Jugendmedizin, Schwerpunkt Stammzelltransplantation Frankfurt am Main Germany
| | | | | | | | - Miguel A. Diaz
- Hospital Infantil Universitario "Niño Jesus" Madrid Spain
| | - Peter J. Shaw
- The Children's Hospital at Westmead Sydney Australia
| | | | - Franco Locatelli
- IRCSS OspedalePediatrico Bambino Gesù, SapienzaUniversity of Rome Rome Italy
| | | | - Maura Faraci
- Hematopoietic stem cell transplantation UnitIstituto Giannina Gaslini Genoa Italy
| | - Filomena Pierri
- Hematopoietic stem cell transplantation UnitIstituto Giannina Gaslini Genoa Italy
| | - Edoardo Lanino
- Hematopoietic stem cell transplantation UnitIstituto Giannina Gaslini Genoa Italy
| | | | | | - Marie Robin
- French reference center for aplastic anemia and PNH;Saint‐Louis HospitalUniversité de Paris Paris France
| | - Carlo Dufour
- UOC EmatologiaIstituto Giannina Gaslini Genoa Italy
| | | |
Collapse
|
23
|
Farhadfar N, Murthy HS, Logan BR, Sees JA, Ayas M, Battiwalla M, Beitinjaneh AM, Chhabra S, Diaz MA, Engles K, Frangoul H, Ganguly S, Gergis U, Kamani NR, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Norkin M, O' Donnell PV, Olsson RF, Rossmann S, Savani BN, Schears R, Seo S, Solh MM, Spitzer T, Sugrue M, Yared JA, Linenberger M, Schwartz J, Pulsipher MA, Shah NN, Switzer GE, Confer DL, Shaw BE, Wingard JR. Correction: Impact of autologous blood transfusion after bone marrow harvest on unrelated donor's health and outcome: a CIBMTR analysis. Bone Marrow Transplant 2020; 56:522. [PMID: 32514157 DOI: 10.1038/s41409-020-0963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nosha Farhadfar
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Sees
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Katie Engles
- CW Bill Young Marrow Donor Program, Kensington, MD, USA
| | - Haydar Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | | | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, NY, USA
| | - Maxim Norkin
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, MN, USA
| | | | - Melhem M Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | | | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Dennis L Confer
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.,National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| |
Collapse
|
24
|
Farhadfar N, Murthy HS, Logan BR, Sees JA, Ayas M, Battiwalla M, Beitinjaneh AM, Chhabra S, Diaz MA, Engles K, Frangoul H, Ganguly S, Gergis U, Kamani NR, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Norkin M, O' Donnell PV, Olsson RF, Rossmann S, Savani BN, Schears R, Seo S, Solh MM, Spitzer T, Sugrue M, Yared JA, Linenberger M, Schwartz J, Pulsipher MA, Shah NN, Switzer GE, Confer DL, Shaw BE, Wingard JR. Impact of autologous blood transfusion after bone marrow harvest on unrelated donor's health and outcome: a CIBMTR analysis. Bone Marrow Transplant 2020; 55:2121-2131. [PMID: 32355289 DOI: 10.1038/s41409-020-0911-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 01/28/2023]
Abstract
Pre-harvest autologous blood collection from bone marrow (BM) donors is performed to meet potential post-operative transfusion needs. This study examines the impact of autologous blood transfusion on BM donor's health and safety. The study included first-time unrelated BM donors from the United States whose BM harvest was facilitated by the National Marrow Donor Program (NMDP) centers between 2006 and 2017. Examination of 7024 BM donors revealed that 60% received at least one unit of autologous blood. The donors who received autologous blood were older, had lower hemoglobin pre-harvest, underwent longer duration of anesthesia, and higher volume BM harvest. Only donors who underwent high-volume BM harvest, defined as a BM harvest volume >27% of donor's blood volume, benefited from autologous transfusion. After a high-volume BM harvest, autologous blood transfusion was shown to decrease grade 2 to 4 collection-associated toxicities within 48 h of BM donation (p = 0.010) and shorten the time to donor-reported "complete" recovery from donation-associated symptoms (p < 0.001). Therefore, autologous transfusion could be avoided as support of marrow donation in the majority of unrelated BM donors and should be limited to cases where the planned BM harvest volume is expected to exceed 27% of donor's blood volume.
Collapse
Affiliation(s)
- Nosha Farhadfar
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Sees
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Katie Engles
- CW Bill Young Marrow Donor Program, Kensington, MD, USA
| | - Haydar Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | | | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, NY, USA
| | - Maxim Norkin
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, MN, USA
| | | | - Melhem M Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | | | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Dennis L Confer
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.,National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| |
Collapse
|
25
|
Alsaedi HS, Alseraihy A, Ayas M, Ghemlas I, Alahmari A, AlJefri A, Alanazi A, Lacson F, AlMeshari N, AlNafee K, Jafri R, Mohammed V. Minimizing Hospital Acquired Infections in Post- Hematopoietic Stem Cell Transplant Pediatric Recipients: Impact on Hospital - Metrics of a Tertiary Care Centre. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
26
|
Alsaedi HS, Mohammed R, Ayas M, Siddiqui K, Ghemlas I, AlMusa H, AlSaud B, Arnaout R, AlDhekri H, Jafri R, Alahmari A, AlJefri A, Alseraihy A. HLA-Haploidentical Transplantation in Children with Primary Immunodeficiency Using Post Cyclophosphamide. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
AlDawsari G, Elhaddad A, El Fakih R, Ben Othman T, Ahmed P, Ghavamzadeh A, Bazarbachi A, Dasouki MJ, Fathy G, Alzahrani H, Samra M, Torjemane L, Satti TM, Shaheen M, Alfraih F, Ayas M, Alahmari A, Alhayli S, Nassar A, Abboud M, Abdelfattah R, El Solh H, Hashmi S, Elhassan T, Ahmed SO, Aljurf M. Outcome of hematopoietic stem cell transplantation (HCT) from HLA-matched related donor for Fanconi anemia (FA) in adolescents and adults: a retrospective study by Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT). Bone Marrow Transplant 2020; 55:1485-1490. [PMID: 32024988 DOI: 10.1038/s41409-020-0809-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/12/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022]
Abstract
Hematopoietic Stem Cell Transplantation (HSCT) is the only potentially curative treatment option for the hematologic complications that occur in patients with Fanconi anemia (FA). In this study, we present a retrospective multicenter analysis from the Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT) of matched related donor HSCT for FA in adolescents and adults transplanted between 1988 and 2015. Forty-five patients received HSCT with a median age at transplant of 18 years, the interquartile range (IQR) (15-23.5); 25 (55.6%) patients were females and 20 (44.4%) were males. Conditioning regimen was fludarabine-based in 29 (64.4%) patients, irradiation-based in five (11.1%) patients, and the remaining patients received other combinations. Indication for HSCT was bone marrow failure in 39 (86.7%) and myelodysplastic syndrome in six (13.3%) patients. Stem cell source was bone marrow in 22 (48.9%), peripheral blood in 20 (44.4%), umbilical cord blood in one (2.2%), and combination of bone marrow and cord blood in two (4.4%) patients. Twenty-seven (60%) patients engrafted and five (11.1%) had primary engraftment failure. The median time to neutrophil engraftment was 14 days (range 10-21 days); median time for platelet engraftment was 17 days (10-33 days). The probability of developing grade II-IV acute GVHD for all patients was 7.0% and chronic GVHD 36.6%. No new malignancies were reported. The OS probability was 53.6% (95% CI, 38.3-68.9%) with a median follow-up of 13 months (95% CI, 1-240). Our HLA-matched related HSCT results in AYA patients with FA compare favorably with other reported international registry data.
Collapse
Affiliation(s)
- Ghuzayel AlDawsari
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. .,Internal Medicine Department, Royal Commission Health Service Program, AL-Lulu Road18, Jubial Industrial City, 11994, Saudi Arabia.
| | - Alaa Elhaddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - Riad El Fakih
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Parvez Ahmed
- Armed Forces Institute of Transplantation, Rawalpindi, Pakistan
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and SCT Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Bazarbachi
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Majed J Dasouki
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Gamal Fathy
- Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Hazzaa Alzahrani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed Samra
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - Lamia Torjemane
- Centre National de Greffe de la Moelle Osseuse, Tunis, Tunisia
| | | | - Marwan Shaheen
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Feras Alfraih
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali Alahmari
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saud Alhayli
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Amr Nassar
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - Miguel Abboud
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Hassan El Solh
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Shahrukh Hashmi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Tusneem Elhassan
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Syed Osman Ahmed
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| |
Collapse
|
28
|
Alsaleh M, Alkofide A, Ali A, Ghemlas I, Aljefri A, Ayas M, Alseraihy A, Elenazi A, Alahmari A, Alfawaz I, Bushnak D, Hazeem M, Ahmad A, Farhan N, Alhmouz A. Incidence of venous thromboembolism (VTE) in childhood cancers from a tertiary care centre: a unique registry initiative with an open invitation. Leuk Res 2019. [DOI: 10.1016/s0145-2126(19)30270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Belgaumi AF, Pathan GQ, Siddiqui K, Ali AA, Al-Fawaz I, Al-Sweedan S, Ayas M, Al-Kofide AA. Incidence, clinical distribution, and patient characteristics of childhood cancer in Saudi Arabia: A population-based analysis. Pediatr Blood Cancer 2019; 66:e27684. [PMID: 30803142 DOI: 10.1002/pbc.27684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/08/2019] [Accepted: 02/06/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE Information regarding the incidence and patterns of childhood malignancies is disproportionately overrepresented by high-income countries, representing mainly the Caucasian population. There is a need to evaluate and disseminate information for other ethnicities, particularly from the Middle East. METHODS Data from the National Cancer Registry, Saudi Arabia (SA-NCR), for pediatric patients (age 0-14 years) diagnosed between 2005 and 2009 and for similar patients at our institution during the same period were analyzed. Population numbers reported in the 2007 national census were used to calculate the annual incidence of childhood cancer. RESULTS Data from SA-NCR on 3885 patients were included in this analysis. The median age was 5.58 years, and 57.3% were males. The annual age-specific cancer incidence rate (ASR) for children in SA is 99.83 per million population; ASR per million for lymphoid leukemia is 25.75, 12.05 for brain tumors, and 9.82 for Hodgkin lymphoma. Of all childhood cancers in SA, 35% were treated at our institution. The five-year overall survival for these 1350 patients is 74.6% (median follow-up 7.52 years [95% confidence interval: 7.36-7.68]). Significant differences in the distribution of childhood malignancy subtypes were evident compared with other countries. CONCLUSION We have reported differences in the cancer ASR and cancer subtype distribution for children in SA as compared with the worldwide incidence and with other populations. This paper provides a comprehensive epidemiological overview of childhood cancer in SA, which could be extrapolated to other regional Arab populations.
Collapse
Affiliation(s)
- Asim F Belgaumi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Ghulam Q Pathan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Afshan A Ali
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Ibrahim Al-Fawaz
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Suleimman Al-Sweedan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Jordan University of Science and Technology, Irbid, Jordan
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Al-Faisal University, Riyadh, Saudi Arabia
| | - Amani A Al-Kofide
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Al-Faisal University, Riyadh, Saudi Arabia
| |
Collapse
|
30
|
Ayas MF, Al-Seraihi A, Al-Agil A, Al-Ahmari A, Ghemlas I, Ayas M. Successful hematopoietic cell transplantation in Fanconi anemia patients with renal impairment using ultra-reduced doses of cyclophosphamide and fludarabine. Pediatr Blood Cancer 2018; 65:e27371. [PMID: 30070008 DOI: 10.1002/pbc.27371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 11/11/2022]
Abstract
Hematopoietic cell transplantation (HCT) remains until now the only curative modality for hematological manifestations in patients with Fanconi anemia (FA). The doses of alkylating agents used in the conditioning of this patient population before HCT are usually significantly decreased due to the genomic instability of the FA cells. FA patients with renal impairment represent a dilemma because of the need to further modify the conditioning regimen according to the degree of renal impairment to avoid additional toxicity. At our institution, we successfully transplanted three FA patients using an ultra-modified regimen.
Collapse
Affiliation(s)
| | - Amal Al-Seraihi
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Agil
- Department of Pharmaceutical Care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
31
|
Jastaniah W, Aljefri A, Ayas M, Alharbi M, Alkhayat N, Al-Anzi F, Yassin F, Alkasim F, Alharbi Q, Abdullah S, Abrar MB, Alsultan A. Prevalence of hereditary cancer susceptibility syndromes in children with cancer in a highly consanguineous population. Cancer Epidemiol 2018; 55:88-95. [PMID: 29859499 DOI: 10.1016/j.canep.2018.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/08/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIM Hereditary cancer susceptibility syndromes (HCSS) are reported in up to one-third of children with cancer. Diagnosis of HCSS is crucial for implementation of surveillance protocols. We identified children who fulfilled criteria for HCSS in Saudi Arabia using the American College of Medical Genetics and Genomics (ACMG) guidelines, addressing the utility of these guidelines in a highly consanguineous population. METHODS This multi-center cross-sectional study recruited 1858 children with cancer between January 2011 and December 2014. HCSS criteria were based on the ACMG guidelines. RESULTS Seven hundred and four (40.4%) out of 1742 eligible patients fulfilled criteria for HCSS. Consanguinity was reported in 629 (38%) patients, with 50 (2.9%) first-degree, 535 (30.7%) second-degree, and 272 (15.6%) third-degree relatives affected with cancer. Two hundred and eighty eight (17.4%) leukemia and 87 (5.3%) brain tumour patients fulfilled HCSS criteria, with parental consanguinity being the most frequent criterion in both (leukemia 85.4%, brain tumors 83.9%). However, leukemia was less frequent in patients of consanguineous parents (p = 0.023). CONCLUSION Four out of 10 children with cancer fulfilled criteria for HCSS, most often due to consanguinity. This higher than expected prevalence suggests the need to validate consanguinity as a criterion for HCSS in highly consanguineous populations.
Collapse
Affiliation(s)
- Wasil Jastaniah
- Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; Chairman Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Abdullah Aljefri
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Musa Alharbi
- Consultant Pediatric Hematology/Oncology/BMT and Chairman of the Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Alkhayat
- Consultant Pediatric Hematology/Oncology/BMT, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faisal Al-Anzi
- Chief Executive Officer and Consultant Pediatric Hematology/Oncology/BMT, Prince Faisal Bin Bandar Cancer Center, Qaseem, Saudi Arabia
| | - Fawwaz Yassin
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Fawaz Alkasim
- Consultant Pediatric Hematology/Oncology/BMT, King Saud Medical City, Riyadh, Saudi Arabia
| | - Qasim Alharbi
- Consultant Pediatric Hematology/Oncology/BMT, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shaker Abdullah
- Consultant Pediatric Hematology/Oncology/BMT and Head Section of Pediatric Hematology/Oncology/BMT, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Burhan Abrar
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Consultant Pediatric Hematology/Oncology/BMT, Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
32
|
Paviglianiti A, Dalle JH, Ayas M, Boelens JJ, Volt F, Iori AP, de Souza MP, Diaz MA, Michel G, Locatelli F, Jubert C, Yakoub-Agha I, Bittencourt H, Bertrand Y, Kenzey C, Tozatto Maio K, Hayashi H, Rocha V, Bader P, Gluckman E, Ruggeri A. Low Body Mass Index Is Associated with Increased Risk of Acute GVHD after Umbilical Cord Blood Transplantation in Children and Young Adults with Acute Leukemia: A Study on Behalf of Eurocord and the EBMT Pediatric Disease Working Party. Biol Blood Marrow Transplant 2017; 24:799-805. [PMID: 29288817 DOI: 10.1016/j.bbmt.2017.12.790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/19/2017] [Indexed: 01/19/2023]
Abstract
Body mass index (BMI) may influence outcomes after allogeneic hematopoietic stem cell transplantation (HSCT). However, the impact of BMI on survival in children undergoing HSCT is not well defined, with conflicting results being reported on this issue. We analyzed 855 patients age 2 to 20 years with diagnosis of acute leukemia who underwent umbilical cord blood transplantation (UCBT) from 1990 to 2015. Patients were classified according to BMI as normal (fifth to 85th percentile), underweight (less than fifth percentile), overweight (85th to 95th percentile), and obese (>95th percentile) using growth charts for age and sex. All patients received single-unit UCBT after a myeloablative conditioning regimen. Diagnosis was acute lymphoblastic leukemia in 68% of the patients. Sixty-one percent of patients (n = 523) were in the normal BMI category, 11% (n = 96) were underweight, 16% (n = 137) overweight, and 12% (n = 99) obese. The cumulative incidence of grade II to IV acute graft-versus-host disease (aGVHD) was 35% (32% to 38%). According to pretransplantation BMI, aGVHD was 46% (33% to 59%) for underweight, 34% (31% to 42%) for normal, 36% (18% to 38%) for overweight, and 27% (15% to 37%) for obese (P = .04). In multivariate analysis, a BMI less than the fifth percentile was associated with higher incidence of acute grade II to IV GVHD compared with normal-BMI patients (hazard ratio, 1.61; 95% confidence interval, 1.15 to 2.26; P = .006). Our results show that being underweight at the time of transplantation is associated with an increased risk of aGVHD, highlighting the importance of nutritional status before UCBT.
Collapse
Affiliation(s)
- Annalisa Paviglianiti
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco.
| | - Jean Hugues Dalle
- Pediatric Hematology Department, Hospital Robert Debré, Paris, Paris 7-Paris Diderot University, Paris, France
| | - Mouhab Ayas
- Pediatric Stem Cell Transplant, Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jan Jaap Boelens
- Department of Pediatrics, Pediatric Blood and Marrow Transplantation Program, University Medical Center, Utrecht, the Netherlands
| | - Fernanda Volt
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Anna Paola Iori
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Miguel Angel Diaz
- Stem Cell Transplant Unit, Hospital Universitario Niño Jesus, Madrid, Spain
| | - Gerard Michel
- Department of Pediatric Hematology and Oncology, Timone Enfants Hospital, APHM and Aix Marseille Université, Marseille, France
| | - Franco Locatelli
- Department of Paediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Bambino Gesù" Children's Hospital, Rome, Italy; Department of Pediatric Sciences, University of Pavia, Rome, Italy
| | - Charlotte Jubert
- Pediatric Hematology Department, Bordeaux-Hospital, Bordeaux University, Lille, France
| | | | - Henrique Bittencourt
- Department of Pediatrics, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Yves Bertrand
- Department of Child Hematology and Oncology, IHOP University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Chantal Kenzey
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Karina Tozatto Maio
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Hiromi Hayashi
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Hopital Saint Antoine, Service d'Hématologie et thérapie cellulaire, Paris, France
| |
Collapse
|
33
|
|
34
|
Qayed M, Wang T, Hemmer MT, Spellman S, Arora M, Couriel D, Alousi A, Pidala J, Abdel-Azim H, Aljurf M, Ayas M, Bitan M, Cairo M, Choi SW, Dandoy C, Delgado D, Gale RP, Hale G, Frangoul H, Kamble RT, Kharfan-Dabaja M, Lehman L, Levine J, MacMillan M, Marks DI, Nishihori T, Olsson RF, Hematti P, Ringden O, Saad A, Satwani P, Savani BN, Schultz KR, Seo S, Shenoy S, Waller EK, Yu L, Horowitz MM, Horan J. Influence of Age on Acute and Chronic GVHD in Children Undergoing HLA-Identical Sibling Bone Marrow Transplantation for Acute Leukemia: Implications for Prophylaxis. Biol Blood Marrow Transplant 2017; 24:521-528. [PMID: 29155316 DOI: 10.1016/j.bbmt.2017.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
Relapse remains the major cause of mortality after hematopoietic cell transplantation (HCT) for pediatric acute leukemia. Previous research has suggested that reducing the intensity of calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis may be an effective strategy for abrogating the risk of relapse in pediatric patients undergoing matched sibling donor (MSD) HCT. We reasoned that the benefits of this strategy could be maximized by selectively applying it to those patients least likely to develop GVHD. We conducted a study of risk factors for GVHD, to risk-stratify patients based on age. Patients age <18 years with leukemia who received myeloablative, T cell-replete MSD bone marrow transplantation and calcineurin inhibitor-based GVHD prophylaxis between 2000 and 2013 and were entered into the Center for International Blood and Marrow Transplant Research registry were included. The cumulative incidence of grade II-IV acute GVHD (aGVHD) was 19%, that of grade II-IV aGVHD 7%, and that of chronic GVHD (cGVHD) was 16%. Compared with age 13 to 18 years, age 2 to 12 years was associated with a lower risk of grade II-IV aGVHD (hazard ratio [HR], .42; 95% confidence interval [CI], .26 to .70; P = .0008), grade II-IV aGVHD (HR, .24; 95% CI, .10 to .56; P = .001), and cGVHD (HR, .32; 95% CI, .19 to .54; P < .001). Compared with 2000-2004, the risk of grade II-IV aGVHD was lower in children undergoing transplantation in 2005-2008 (HR, .36; 95% CI, .20 to .65; P = .0007) and in 2009-2013 (HR, .24; 95% CI. .11 to .53; P = .0004). Similarly, the risk of grade III-IV aGVHD was lower in children undergoing transplantation in 2005-2008 (HR, .23; 95% CI, .08 to .65; P = .0056) and 2009-2013 (HR, .16; 95% CI, .04 to .67; P = .0126) compared with those doing so in 2000-2004. We conclude that aGVHD rates have decreased significantly over time, and that children age 2 to 12 years are at very low risk for aGVHD and cGVHD. These results should be validated in an independent analysis, because these patients with high-risk malignancies may be good candidates for trials of reduced GVHD prophylaxis.
Collapse
Affiliation(s)
- Muna Qayed
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia.
| | - Tao Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael T Hemmer
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Mukta Arora
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Daniel Couriel
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, Utah Blood and Marrow Transplant Program, Salt Lake City, Utah
| | - Amin Alousi
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Ridayh, Saudi Arabia
| | - Menachem Bitan
- Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Mitchell Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Sung Won Choi
- Department of Pediatrics and Communicable Diseases, The University of Michigan, Ann Arbor, Michigan
| | - Christopher Dandoy
- , Department of Pediatrics, Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Delgado
- Department of Pediatrics, Indiana University Hospital, Indianapolis, Indiana
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Gregory Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Haydar Frangoul
- Pediatric Hematology - Oncology, The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, Tennessee
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Mohamed Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Leslie Lehman
- Department of Pediatrics - Hematology Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John Levine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret MacMillan
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Olov Ringden
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sachiko Seo
- National Cancer Research Center, East Hospital, Kashiwa, Chiba, Japan
| | - Shalini Shenoy
- Department of Pediatrics - Hematology Oncology, Washington University, St. Louis, Missouri
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Lolie Yu
- Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John Horan
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
35
|
Page KM, Labopin M, Ruggeri A, Michel G, Diaz de Heredia C, O'Brien T, Picardi A, Ayas M, Bittencourt H, Vora AJ, Troy J, Bonfim C, Volt F, Gluckman E, Bader P, Kurtzberg J, Rocha V. Factors Associated with Long-Term Risk of Relapse after Unrelated Cord Blood Transplantation in Children with Acute Lymphoblastic Leukemia in Remission. Biol Blood Marrow Transplant 2017; 23:1350-1358. [PMID: 28438676 PMCID: PMC5569913 DOI: 10.1016/j.bbmt.2017.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/16/2017] [Indexed: 12/20/2022]
Abstract
For pediatric patients with acute lymphoblastic leukemia (ALL), relapse is an important cause of treatment failure after unrelated cord blood transplant (UCBT). Compared with other donor sources, relapse is similar or even reduced after UCBT despite less graft-versus-host disease (GVHD). We performed a retrospective analysis to identify risk factors associated with the 5-year cumulative incidence of relapse after UCBT. In this retrospective, registry-based study, we examined the outcomes of 640 children (<18 years) with ALL in first complete remission (CR1; n = 257, 40%) or second complete remission (CR2; n = 383, 60%) who received myeloablative conditioning followed by a single-unit UCBT from 2000 to 2012. Most received antithymocyte globulin (88%) or total body irradiation (TBI; 69%), and cord blood grafts were primarily mismatched at 1 (50%) or 2+ (34%) HLA loci. Considering patients in CR1, the rates of 5-year overall survival (OS), leukemia-free survival (LFS), and relapse were 59%, 52%, and 23%, respectively. In multivariate analysis (MVA), acute GVHD (grades II to IV) and TBI protected against relapse. In patients in CR2, rates of 5-year OS, LFS, and the cumulative incidence of relapse were 46%, 44%, and 28%, respectively. In MVA, longer duration from diagnosis to UCBT (≥30 months) and TBI were associated with decreased relapse risk. Importantly, receiving a fully HLA matched graft was a strong risk factor for increased relapse in MVA. An exploratory analysis of all 640 patients supported the important association between the presence of acute GVHD and less relapse but also demonstrated an increased risk of nonrelapse mortality. In conclusion, the impact of GVHD as a graft-versus-leukemia marker is evident in pediatric ALL after UCBT. Strategies that promote graft-versus-leukemia while harnessing GVHD should be further investigated.
Collapse
Affiliation(s)
- Kristin M Page
- Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina.
| | - Myriam Labopin
- EBMT, Acute Leukemia Working Party, Service d'hematologie et therapie cellulaire, Hôpital Saint Antoine, Paris, France
| | - Annalisa Ruggeri
- EBMT, Acute Leukemia Working Party, Service d'hematologie et therapie cellulaire, Hôpital Saint Antoine, Paris, France; Eurocord, Hospital Saint Louis APHP, University Paris-Diderot, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco-Ville, Monaco
| | - Gerard Michel
- Timone Enfants Hospital and Aix-Marseille University, Department of Pediatric Hematology and Oncology, Marseille, France
| | | | - Tracey O'Brien
- Blood and Marrow Transplant Program, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | - Ajay J Vora
- Department of Pediatric Haematology, The Children's Hospital, Sheffield, UK; Department of Haematology and Oncology, Great Ormond Street Hospital, London, UK
| | - Jesse Troy
- Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina
| | - Carmen Bonfim
- Hospital Das Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Fernanda Volt
- Eurocord, Hospital Saint Louis APHP, University Paris-Diderot, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco-Ville, Monaco
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis APHP, University Paris-Diderot, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco-Ville, Monaco
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Joanne Kurtzberg
- Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina
| | - Vanderson Rocha
- Eurocord, Hospital Saint Louis APHP, University Paris-Diderot, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco-Ville, Monaco; Hospital Das Clinicas, University of Sao Paulo, Sao Paulo, Brazil; Churchill Hospital, Oxford University, Oxford, UK
| |
Collapse
|
36
|
Chaudhury S, Ayas M, Rosen C, Ma M, Viqaruddin M, Parikh S, Kharbanda S, Chiang KY, Haight A, Bhatia M, Guilcher G, Thompson A, Shenoy S. A Multicenter Retrospective Analysis Stressing the Importance of Long-Term Follow-Up after Hematopoietic Cell Transplantation for β-Thalassemia. Biol Blood Marrow Transplant 2017. [PMID: 28627425 DOI: 10.1016/j.bbmt.2017.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is curative in patients with β-thalassemia major. However, most reports on HCT outcomes lack long-term follow-up data with the exception of single-center reports. An international multicenter retrospective data collection and analysis was conducted in 176 β-thalassemia patients who were 1 year or beyond after first HCT to evaluate follow-up methods and outcomes at 7 centers. Median age at HCT was 5.5 years (range, .6 to 18.5), and median follow-up was 7 years (range, 1 to 20). HCT was predominantly from HLA-matched related donors (91%) with bone marrow as stem cell source (91%) and myeloablative conditioning regimens (88%). Late mortality or persistent chronic graft-versus-host disease (GVHD) was rare (<2%). Graft rejection was reported in 23% (24% of these occurred beyond 1 year) post-HCT. Of 119 patients with donor chimerism results available for ≥4 years post-HCT, 50% had >95%, 22% had 50% to 95%, 7% had 20% to 50% and 25 (21%) had <20% donor chimerism. Organ dysfunction was identified in 10% pre-HCT and in 20% post-HCT even without complete clinical details on all patients. Hypogonadism and elevated creatinine for age were most commonly reported and significantly higher in recipients ≥ 7 years at the time of HCT (P = .007) and in those with pre-existing morbidity before HCT (P = .02). Outcomes were unaffected by pre-HCT ferritin or GVHD. Mean z scores for height and weight were low at baseline and remained low post-HCT (79%), confirming that growth impairment from disease lacked recovery post-HCT during this follow-up period. HCT for β-thalassemia has a high rate of cure and low mortality, especially in the young and from HLA-matched related donors. Half of the number of recipients live with mixed chimerism that requires continued follow-up because of a risk of late graft rejection (14%). Organ function after HCT when <7 years of age was generally preserved. Hypogonadism, renal dysfunction, and growth impairment that failed to correct were late complications identified most frequently in older transplant recipients. Systematic follow-up of individual organs such as lung and heart were inadequate but important. These data support the development of simple measures of uniformly tracking long-term HCT outcomes and organ functions in children and adolescents who undergo HCT for thalassemia, allowing for systematic identification and implementation of standardized surveillance strategies and interventions.
Collapse
Affiliation(s)
- Sonali Chaudhury
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois.
| | - M Ayas
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Colleen Rosen
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Madeline Ma
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - M Viqaruddin
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Suhag Parikh
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Sandhya Kharbanda
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - K Y Chiang
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Ann Haight
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Monica Bhatia
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Greg Guilcher
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Alexis Thompson
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| | - Shalini Shenoy
- Pediatric Hematology/Oncology Stem Cell transplant, Childrens Memorial Hospital, Chicago, Illinois
| |
Collapse
|
37
|
Kekre N, Zhang Y, Zhang MJ, Carreras J, Ahmed P, Anderlini P, Atta EH, Ayas M, Boelens JJ, Bonfim C, Deeg HJ, Kapoor N, Lee JW, Nakamura R, Pulsipher MA, Eapen M, Antin JH. Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia. Haematologica 2017; 102:1291-1298. [PMID: 28341733 PMCID: PMC5566045 DOI: 10.3324/haematol.2017.164459] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/16/2017] [Indexed: 12/04/2022] Open
Abstract
For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% versus 6%, P<0.001) and chronic (20% versus 9%, P<0.001) graft-versus-host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, P=0.76, respectively. Among recipients of unrelated donor transplants, acute graft-versus-host disease was also higher with horse compared to rabbit antithymocyte globulin (42% versus 23%, P<0.001) but not chronic graft-versus-host disease (38% versus 32%, P=0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% versus 83%, P=0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.
Collapse
Affiliation(s)
- Natasha Kekre
- Division of Hematology, The Ottawa Hospital, ON, Canada
| | - Ying Zhang
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mei-Jie Zhang
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.,Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parvez Ahmed
- Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Jaap Jan Boelens
- Department of Pediatrics, University Medical Center Utrecht, The Netherlands
| | - Carmem Bonfim
- Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil
| | - H Joachim Deeg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Neena Kapoor
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, CA, USA
| | - Jong-Wook Lee
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, CA, USA
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
38
|
Gluckman E, Cappelli B, Bernaudin F, Labopin M, Volt F, Carreras J, Pinto Simões B, Ferster A, Dupont S, de la Fuente J, Dalle JH, Zecca M, Walters MC, Krishnamurti L, Bhatia M, Leung K, Yanik G, Kurtzberg J, Dhedin N, Kuentz M, Michel G, Apperley J, Lutz P, Neven B, Bertrand Y, Vannier JP, Ayas M, Cavazzana M, Matthes-Martin S, Rocha V, Elayoubi H, Kenzey C, Bader P, Locatelli F, Ruggeri A, Eapen M. Sickle cell disease: an international survey of results of HLA-identical sibling hematopoietic stem cell transplantation. Blood 2017; 129:1548-1556. [PMID: 27965196 PMCID: PMC5356458 DOI: 10.1182/blood-2016-10-745711] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/01/2016] [Indexed: 12/17/2022] Open
Abstract
Despite advances in supportive therapy to prevent complications of sickle cell disease (SCD), access to care is not universal. Hematopoietic cell transplantation is, to date, the only curative therapy for SCD, but its application is limited by availability of a suitable HLA-matched donor and lack of awareness of the benefits of transplant. Included in this study are 1000 recipients of HLA-identical sibling transplants performed between 1986 and 2013 and reported to the European Society for Blood and Marrow Transplantation, Eurocord, and the Center for International Blood and Marrow Transplant Research. The primary endpoint was event-free survival, defined as being alive without graft failure; risk factors were studied using a Cox regression models. The median age at transplantation was 9 years, and the median follow-up was longer than 5 years. Most patients received a myeloablative conditioning regimen (n = 873; 87%); the remainder received reduced-intensity conditioning regimens (n = 125; 13%). Bone marrow was the predominant stem cell source (n = 839; 84%); peripheral blood and cord blood progenitors were used in 73 (7%) and 88 (9%) patients, respectively. The 5-year event-free survival and overall survival were 91.4% (95% confidence interval, 89.6%-93.3%) and 92.9% (95% confidence interval, 91.1%-94.6%), respectively. Event-free survival was lower with increasing age at transplantation (hazard ratio [HR], 1.09; P < .001) and higher for transplantations performed after 2006 (HR, 0.95; P = .013). Twenty-three patients experienced graft failure, and 70 patients (7%) died, with the most common cause of death being infection. The excellent outcome of a cohort transplanted over the course of 3 decades confirms the role of HLA-identical sibling transplantation for children and adults with SCD.
Collapse
Affiliation(s)
- Eliane Gluckman
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Barbara Cappelli
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Francoise Bernaudin
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal Créteil, Paris XII University, Créteil, France
| | - Myriam Labopin
- European Society for Blood and Marrow Transplantation Statistical Unit, Hospital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fernanda Volt
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Jeanette Carreras
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | - Alina Ferster
- Hemato-Oncology Unit, Hospital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Dupont
- Cliniques Universitaires Saint Luc, Hemato-Oncology Unit, Brussels, Belgium
| | - Josu de la Fuente
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Jean-Hugues Dalle
- Hemato-immunology, Hospital Robert Debré and Paris-Diderot University, Paris, France
| | - Marco Zecca
- Pediatric Hematology-Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Mark C Walters
- University of California San Francisco Benioff Children's Hospital, Oakland, CA
| | | | - Monica Bhatia
- Morgan Stanley Children's Hospital of New York, New York, NY
| | | | | | - Joanne Kurtzberg
- Pediatric Blood and Marrow Transplant Program, Duke University Medical Center, Durham, NC
| | - Nathalie Dhedin
- Adolescent and Young Adults Hematology Department, Hospital Saint-Louis, Paris, France
| | - Mathieu Kuentz
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal Créteil, Paris XII University, Créteil, France
| | - Gerard Michel
- Department of Pediatric Hematology and Oncology and Research Unit Equipe d'Accueil 3279, Aix-Marseille University and Timone Children's Hospital Marseille, Marseille, France
| | - Jane Apperley
- Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Patrick Lutz
- Service D'hémato Oncologie Pédiatrique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Bénédicte Neven
- Pediatric Hematology-Immunology Department, Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Bertrand
- Department of Pediatric Hematology and Oncology, University Hospital of Lyon, Lyon, France
| | - Jean Pierre Vannier
- Equipe d'Accueil 3829, Institut de Recherche et d'Innovation Biomédicale, Faculté de Médecine-Pharmacie, Rouen, France
| | - Mouhab Ayas
- Paediatric Haematology/Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Marina Cavazzana
- Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, Paris, France
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | | | - Vanderson Rocha
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France
- Hospital Sirio-Libanes, and Serviço de Hematologia, Hemoterapia e Terapia Celular, São Paulo University, São Paulo, Brazil
- Churchill Hospital, Oxford, United Kingdom
| | - Hanadi Elayoubi
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Peter Bader
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Franco Locatelli
- Dipartimento di Oncoematologia Pediatrica, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Bambino Gesù, Rome, Italy
- Dipartimento di Scienze Pediatriche, Università di Pavia, Pavia, Italy; and
| | - Annalisa Ruggeri
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
- Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris, France
| | - Mary Eapen
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
39
|
Khoury HJ, Wang T, Hemmer MT, Couriel D, Alousi A, Cutler C, Aljurf M, Antin JH, Ayas M, Battiwalla M, Cahn JY, Cairo M, Chen YB, Gale RP, Hashmi S, Hayashi RJ, Jagasia M, Juckett M, Kamble RT, Kharfan-Dabaja M, Litzow M, Majhail N, Miller A, Nishihori T, Qayed M, Schoemans H, Schouten HC, Socie G, Storek J, Verdonck L, Vij R, Wood WA, Yu L, Martino R, Carabasi M, Dandoy C, Gergis U, Hematti P, Solh M, Jamani K, Lehmann L, Savani B, Schultz KR, Wirk BM, Spellman S, Arora M, Pidala J. Improved survival after acute graft- versus-host disease diagnosis in the modern era. Haematologica 2017; 102:958-966. [PMID: 28302712 PMCID: PMC5477615 DOI: 10.3324/haematol.2016.156356] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/07/2017] [Indexed: 12/17/2022] Open
Abstract
A cute graft-versus-host disease remains a major threat to a successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in improved outcome specifically among those diagnosed with acute graft-versus-host disease. We examined outcome following diagnosis of grade II-IV acute graft-versus-host disease according to time period, and explored effects according to original graft-versus-host disease prophylaxis regimen and maximum overall grade of acute graft-versus-host disease. Between 1999 and 2012, 2,905 patients with acute myeloid leukemia (56%), acute lymphoblastic leukemia (30%) or myelodysplastic syndromes (14%) received a sibling (24%) or unrelated donor (76%) blood (66%) or marrow (34%) transplant and developed grade II-IV acute graft-versus-host disease (n=497 for 1999–2001, n=962 for 2002–2005, n=1,446 for 2006–2010). The median (range) follow-up was 144 (4–174), 97 (4–147) and 60 (8–99) months for 1999–2001, 2002–2005, and 2006–2010, respectively. Among the cohort with grade II-IV acute graft-versus-host disease, there was a decrease in the proportion of grade III-IV disease over time with 56%, 47%, and 37% for 1999–2001, 2002–2005, and 2006–2012, respectively (P<0.001). Considering the total study population, univariate analysis demonstrated significant improvements in overall survival and treatment-related mortality over time, and deaths from organ failure and infection declined. On multivariate analysis, significant improvements in overall survival (P=0.003) and treatment-related mortality (P=0.008) were only noted among those originally treated with tacrolimus-based graft-versus-host disease prophylaxis, and these effects were most apparent among those with overall grade II acute graft-versus-host disease. In conclusion, survival has improved over time for tacrolimus-treated transplant recipients with acute graft-versus-host disease.
Collapse
Affiliation(s)
- Hanna J Khoury
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Tao Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael T Hemmer
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel Couriel
- Utah Blood and Marrow Transplant Program-Adults, Salt Lake City, UT, USA
| | - Amin Alousi
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Corey Cutler
- Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mahmoud Aljurf
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Joseph H Antin
- Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung and Blood Institute-NIH, Bethesda, MD, USA
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Mitchell Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, UK
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic Rochester, MN, USA.,Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, MO, USA
| | - Madan Jagasia
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark Juckett
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mark Litzow
- Department of Internal Medicine, Mayo Clinic Rochester, MN, USA
| | - Navneet Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Alan Miller
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Muna Qayed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, the Netherlands
| | - Gerard Socie
- Department of Hematology, Hopital Saint Louis, Paris, France
| | - Jan Storek
- Department of Medicine, University of Calgary, AB, Canada
| | | | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Lolie Yu
- Division of Hematology/Oncology & HSCT, The Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University Medical Center, New Orleans, LA, USA
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | | | - Usama Gergis
- Hematologic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, NY, USA
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Melham Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Kareem Jamani
- Department of Medicine, University of Calgary, AB, Canada
| | - Leslie Lehmann
- Dana Farber Cancer Institute/Boston Children's Hospital, MA, USA
| | - Bipin Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, WA, USA
| | - Stephen Spellman
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be the Match, Minneapolis, MN, USA
| | - Mukta Arora
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
40
|
al-Sweedan S, Siddiqui K, Jafri R, Alahmari A, Ghemlas I, Ayas M, Farhan N, Alseraihy A. Stem Cell Transplantation (SCT) in Pediatric Acute Myeloid Leukemia (AML) – Reporting 8 Years of Data From a CIBMTR Member Centre, King Faisal Specialist Hospital and Research Centre, Riaydh, Saudi Arabia. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
41
|
Al-Sweedan S, Al-Seraihy A, Al-Ahmari A, Al-Jefri A, Mohammed V, Jafri R, Siddiqui K, Ayas M. Factors Determining the Outcome of Hematopoietic Stem Cell Transplantation in Patients With Acute Lymphoblastic Leukemia at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. J Pediatr Hematol Oncol 2017; 39:33-37. [PMID: 27906795 DOI: 10.1097/mph.0000000000000679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Medical records of 82 patients with acute lymphoblastic leukemia (ALL) who underwent hematopoietic cell transplantation (HCT) at our institution from 2005 to 2011 were reviewed. Forty-five patients were male (54.8%). The median age at HCT was 7.46 years (range, 0.98 to 14.31 y), the median time to HCT after diagnosis was 12.56 months. Ten patients were below the age of 1 year (12%). All patients were in complete remission at the time of HCT. In 83 transplants, 64 patients received HCT from human leukocyte antigen-identical-related donors and 19 from other donors. Stem cell source was bone marrow in 65 (78%) and cord blood in 18 (22%). Five-year overall survival was 58.8% and event-free survival was 54.3%. The cumulative incidence of acute graft versus host disease was 4.8%±2.3% and of chronic graft versus host disease was 8.9%±3.2%. The median time to absolute neutrophil count and platelet recovery was 17 days (range, 12 to 43 d) and 28 days (range, 15 to 98 d), respectively. One patient acquired CMV infection after transplant. No one developed venoocclusive disease, hemorrhagic cystitis, or other complication. Patient's age at diagnosis, sex, donor's human leukocyte antigen status and sex, source of transplant and complete remission status at HCT did not affect overall survival and event-free survival. Our results show a favorable outcome to HCT for acute lymphoblastic leukemia patients comparable to published data, and no single factor was associated with superior outcome.
Collapse
Affiliation(s)
- Suleimman Al-Sweedan
- *Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia †Jordan University of Science & Technology, Irbid, Jordan
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Al-Mousa H, Hawwari A, Al-Ghonaium A, Al-Saud B, Al-Dhekri H, Al-Muhsen S, Elshorbagi S, Dasouki M, El-Baik L, Alseraihy A, Ayas M, Arnaout R. Hematopoietic stem cell transplantation corrects WIP deficiency. J Allergy Clin Immunol 2016; 139:1039-1040.e4. [PMID: 27742395 DOI: 10.1016/j.jaci.2016.08.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Hamoud Al-Mousa
- Pediatric Allergy and Clinical Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Abbas Hawwari
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Ghonaium
- Pediatric Allergy and Clinical Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Bandar Al-Saud
- Pediatric Allergy and Clinical Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hasan Al-Dhekri
- Pediatric Allergy and Clinical Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saleh Al-Muhsen
- Pediatric Allergy and Clinical Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; King Khaled University Hospital, Pediatric Allergy and Clinical Immunology, Riyadh, Saudi Arabia
| | - Sahar Elshorbagi
- Pediatric Allergy and Clinical Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Majed Dasouki
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Lina El-Baik
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Alseraihy
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Rand Arnaout
- Pediatric Allergy and Clinical Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
43
|
Hussein AA, Hamidieh AA, Elhaddad A, Ramzi M, Othman TB, Hussain F, Dennison D, Ahmed P, Abboud M, Al-Ahmari A, Wahadneh A, Fathy J, Bekadja MA, Al-Kindi S, Benchekroun S, Ibrahim A, Behfar M, Samra M, Ladeb S, Adil S, El-Solh H, Ayas M, Aljurf M, Ghavamzadeh A, Al-Seraihy A. First report of pediatric hematopoietic stem cell transplantation activities in the eastern mediterranean region from 1984 to 2011: on behalf of the pediatric cancer working committee of the eastern mediterranean blood and marrow transplantation group. Bone Marrow Transplant 2016; 52:120-125. [PMID: 27618684 DOI: 10.1038/bmt.2016.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/02/2016] [Accepted: 07/11/2016] [Indexed: 12/18/2022]
Abstract
To describe the hematopoietic stem cell transplantation (HSCT) activities for children in the Eastern Mediterranean (EM) region, data on transplants performed for children less than 18 years of age between 1984 and 2011 in eight EM countries (Egypt, Iran, Jordan, Lebanon, Oman, Pakistan, Saudi Arabia and Tunisia) were collected. A total of 5187 transplants were performed, of which 4513 (87%) were allogeneic and 674 (13%) were autologous. Overall, the indications for transplantation were malignant diseases in 1736 (38.5%) and non-malignant in 2777 (61.5%) patients. A myeloablative conditioning regimen was used in 88% of the allografts. Bone marrow (BM) was the most frequent source of stem cells (56.2%), although an increasing use of PBSC was observed in the last decade. The stem cell source of autologous HSCT has shifted over time from BM to PBSC, and 80.9% of autologous HSCTs were from PBSCs. The donors for allogeneic transplants were matched-related in 94.5% of the cases, and unrelated transplants, mainly cord blood (99%) in 239 (5.5%) cases. This is the first report to describe the pediatric HSCT activities in EM countries. Non-malignant disorders are the main indication for allogeneic transplantation. Frequency of alternate donor transplantation is low.
Collapse
Affiliation(s)
- A A Hussein
- Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
| | - A A Hamidieh
- Hematology, Oncology and SCT Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - A Elhaddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - M Ramzi
- Shiraz University of Medical Science, Shiraz, Islamic Republic of Iran
| | - T B Othman
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - F Hussain
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - D Dennison
- Sultan Qaboos University Hospital, Muscat, Oman
| | - P Ahmed
- Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan
| | - M Abboud
- American University Beirut Medical Center, Beirut, Lebanon
| | - A Al-Ahmari
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Wahadneh
- Queen Rania Al-Abdullah Children Hospital-King Hussein Medical Center, Amman, Jordan
| | - J Fathy
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - M-A Bekadja
- Oran University-1st November Hospital, Oran, Algeria
| | - S Al-Kindi
- Sultan Qaboos University Hospital, Muscat, Oman
| | - S Benchekroun
- Service d'Hematologie et Oncologie Pediatrique, Casablanca, Morocco
| | - A Ibrahim
- Makassed General Hospital, Beirut, Lebanon
| | - M Behfar
- Hematology, Oncology and SCT Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - M Samra
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - S Ladeb
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - S Adil
- Aga Khan University Hospital, Karachi, Pakistan
| | - H El-Solh
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Ayas
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Ghavamzadeh
- Hematology, Oncology and SCT Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - A Al-Seraihy
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | |
Collapse
|
44
|
Jastaniah W, Aljefri A, Ayas M, Alharbi M, Alkhayat N, Alanzi F, Yassin F, Al-Kasim F, Abdullah S, Abrar MB, Alsultan AS. Prevalence of hereditary cancer susceptibility syndromes in children: A report from the Saudi Arabian Pediatric Hematology Oncology Society. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Wasil Jastaniah
- Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah and King Abdulaziz Medical City - WR, Jeddah, Saudi Arabia
| | - Abdullah Aljefri
- King Faisal Specialist Hospital and Research Center and Al Faisal University, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Nawaf Alkhayat
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faisal Alanzi
- Prince Faisal Bin Bandar Cancer Center, Qaseem, Saudi Arabia
| | - Fawwaz Yassin
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Shaker Abdullah
- King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City - WR, Jeddah, Saudi Arabia
| | | | - Abdulrahman S. Alsultan
- Department of Pediatrics, College of Medicine, King Saud University; and Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
45
|
Ayas M, Siddiqui K, El-solh H, Al-Jefri A, Al-Ahmari A, Al-Ghemlas I, Saleh M, Al-Musa A, Khairi A, Markiz S, Shahin H, Al-Seraihy A. Outcome of Unmanipulated HLA-Mismatched/Haplo-Matched Hematopoietic Cell Transplantation from Related Donors in Patients with Fanconi Anemia Using Low Dose Post HCT Cyclophosphamide for Gvhd Prophylaxis. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
46
|
Chaudhury S, Ayas M, Rosen C, Ma M, Viqarrudin M, Parikh S, Kharbanda S, Chiang KY, Bhatia M, Guilcher G, Thompson AA, Shenoy S. A Multicenter Retrospective Analysis Stressing Importance of Tracking Long Term Outcomes Following Hematopoietic Cell Transplantation (HCT) for â-Thalassemia Major. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
47
|
Ayas M, Siddiqui K, El-solh H, Al-Jefri A, Al-Ahmari A, Al-Ghemlas I, Alsweedan S, Khairi A, Shahin H, Markiz S, Al-Seraihy A. Impact of Race on Gvhd after Unrelated Cord Blood Transplantation: Comparison of Outcome in National and International Cord Blood Units' Recipients. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
Archana G, Bhat M, Ayas M. Auditory neuropathy spectrum disorder in a child with albinism. Indian J Otol 2016. [DOI: 10.4103/0971-7749.192181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
49
|
Al-Saud B, Al-Mousa H, Al-Ahmari A, Al-Ghonaium A, Ayas M, Alhissi S, Al-Muhsen S, Al-Seraihy A, Arnaout R, Al-Dhekri H, Hawwari A. Hematopoietic stem cell transplant for hyper-IgM syndrome due to CD40L defects: A single-center experience. Pediatr Transplant 2015; 19:634-9. [PMID: 26073206 DOI: 10.1111/petr.12538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/01/2022]
Abstract
HIGMI is a disease with a high risk for morbidity and mortality. HSCT has been shown to be a curative option. This study retrospectively reviewed and analyzed data from five patients who received HSCT at King Faisal Specialist Hospital & Research Centre (KFSH&RC) in Riyadh, Saudi Arabia, between 2005 and 2013. Five patients with HIGMI syndrome underwent HSCT at a median age of 41 months (range, 9-72 months). The median time from diagnosis to transplantation was 30 months (range, 5-58 months). For all five patients, the donors were HLA-identical siblings. In three patients, the conditioning regimen was composed of BU and CY. Fludarabine and melphalan with either ATG or alemtuzumab was used in two patients. For GVHD prophylaxis, cyclosporine was used in two patients, and the combination of cyclosporine and MTX was used in three patients. The survival rate was 100%, with a median follow-up of 69 months (range, 13-100 months). All patients engrafted. Two patients developed acute GVHD. Four patients showed complete immune recovery with positive CD40L expression in activated T cells and discontinued IVIG replacement. HSCT in early stage from an HLA-matched sibling donor is potentially effective at curing the disease.
Collapse
Affiliation(s)
- Bandar Al-Saud
- Section of Pediatric Allergy/Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Colleges of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hamoud Al-Mousa
- Section of Pediatric Allergy/Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Colleges of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Colleges of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Ghonaium
- Section of Pediatric Allergy/Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Safa Alhissi
- Department of Genetics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Saleh Al-Muhsen
- Section of Pediatric Allergy/Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amal Al-Seraihy
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rand Arnaout
- Section of Pediatric Allergy/Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Colleges of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hasan Al-Dhekri
- Section of Pediatric Allergy/Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abbas Hawwari
- Department of Genetics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
50
|
Burke MJ, Verneris MR, Le Rademacher J, He W, Abdel-Azim H, Abraham AA, Auletta JJ, Ayas M, Brown VI, Cairo MS, Chan KW, Diaz Perez MA, Dvorak CC, Egeler RM, Eldjerou L, Frangoul H, Guilcher GMT, Hayashi RJ, Ibrahim A, Kasow KA, Leung WH, Olsson RF, Pulsipher MA, Shah N, Shah NN, Thiel E, Talano JA, Kitko CL. Transplant Outcomes for Children with T Cell Acute Lymphoblastic Leukemia in Second Remission: A Report from the Center for International Blood and Marrow Transplant Research. Biol Blood Marrow Transplant 2015; 21:2154-2159. [PMID: 26327632 DOI: 10.1016/j.bbmt.2015.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
Survival for children with relapsed T cell acute lymphoblastic leukemia (T-ALL) is poor when treated with chemotherapy alone, and outcomes after allogeneic hematopoietic cell transplantation (HCT) is not well described. Two hundred twenty-nine children with T-ALL in second complete remission (CR2) received an HCT after myeloablative conditioning between 2000 and 2011 and were reported to the Center for International Blood and Marrow Transplant Research. Median age was 10 years (range, 2 to 18). Donor source was umbilical cord blood (26%), matched sibling bone marrow (38%), or unrelated bone marrow/peripheral blood (36%). Acute (grades II to IV) and chronic graft-versus-host disease occurred in, respectively, 35% (95% confidence interval [CI], 27% to 45%) and 26% (95% CI, 20% to 33%) of patients. Transplant-related mortality at day 100 and 3-year relapse rates were 13% (95% CI, 9% to 18%) and 30% (95% CI, 24% to 37%), respectively. Three-year overall survival and disease-free survival rates were 48% (95% CI, 41% to 55%) and 46% (95% CI, 39% to 52%), respectively. In multivariate analysis, patients with bone marrow relapse, with or without concurrent extramedullary relapse before HCT, were most likely to relapse (hazard ratio, 3.94; P = .005) as compared with isolated extramedullary disease. In conclusion, HCT for pediatric T-ALL in CR2 demonstrates reasonable and durable outcomes, and consideration for HCT is warranted.
Collapse
Affiliation(s)
- Michael J Burke
- Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI.
| | | | - Jennifer Le Rademacher
- CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Wensheng He
- CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Allistair A Abraham
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
| | - Jeffery J Auletta
- Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Valerie I Brown
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, PA
| | - Mitchell S Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Ka Wah Chan
- Department of Pediatrics, Texas Transplant Institute, San Antonio, TX
| | - Miguel A Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Christopher C Dvorak
- Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA
| | - R Maarten Egeler
- Department of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Lamis Eldjerou
- Department of Pediatrics, University of Florida, Gainsville, FL
| | - Haydar Frangoul
- Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Gregory M T Guilcher
- Section of Paediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, AB, Canada
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ahmed Ibrahim
- Department of Hematology/Oncology, Makassed General Hospital, Beiruit, Lebanon
| | - Kimberly A Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wing H Leung
- Division of Bone Marrow Transplantation, St. Jude Children's Research Hospital, Memphis, TN
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Michael A Pulsipher
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Niketa Shah
- Division of Hematology/Oncology, Department of Pediatrics, Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, AZ
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NIH), Bethesda, MD
| | - Elizabeth Thiel
- CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
| | - Carrie L Kitko
- Stem Cell Transplant Program, Department of Pediatrics, Vanderbilt University, Nashville, TN
| |
Collapse
|