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Unrelated Donor Transplants

Low incidence of severe acute graft-versus-host disease in children given haematopoietic stem cell transplantation from unrelated donors prospectively matched for HLA class I and II alleles with high-resolution molecular typing

Bone Marrow Transplantation volume 31, pages 987–993 (2003)Cite this article

Summary:

We evaluated the outcome of 63 children given haematopoietic stem cell transplantation from unrelated donors (URD-HSCT) prospectively selected using DNA high-resolution typing of both HLA class I and class II loci. Thirty patient/donor pairs (48%) were fully matched. Among the others, HSCT was performed in the presence of one (n=22), two (n=9), or three (n=2) HLA disparities. Patients had either malignant (n=46) or non-malignant (n=17) disease. In all cases, graft-versus-host disease (GVHD) prophylaxis consisted of cyclospor-in A, short-term methotrexate and pretransplant anti-thymocyte globulin. The probability of haematopoietic recovery at day 100 was 97%. Two patients experienced primary graft failure. The cumulative probability of grades III–IV acute GVHD and of extensive chronic GVHD equalled 8 and 14%, respectively. A total of 12 patients died of transplant-related complications. The probability of transplant-related mortality (TRM) at 100 and 180 days was 10 and 15%, respectively, whereas the cumulative incidence of TRM was 22%. The probability of GVHD-related mortality equalled 6% at 2.5 years. The overall and disease-free survival rates were 67 and 65%, respectively. URD-HSCT with donor selection based on high-resolution HLA typing is associated with low incidence of both severe acute GVHD and graft failure. The observed outcome is comparable to that of children transplanted from HLA-identical siblings.

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Acknowledgements

This work has been partly supported by grants from AIRC (Associazione Italiana Ricerca sul Cancro), CNR (Consiglio Nazionale delle Ricerche), MURST (Ministero dell'Università e della Ricerca Scientifica e Tecnologica) and IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico S Matteo to FL. We thank Cinzia Pizzochero for her skillful technical assistance.

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Authors and Affiliations

  1. Oncoematologia Pediatrica, IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy

    S Giebel, G Giorgiani, M Zecca, R Maccario & F Locatelli

  2. Department of Haematology and BMT, Silesian Medical Academy, Katowice, Poland

    S Giebel & J Holowiecki

  3. Servizio di Immunoematologia e Trasfusione, Centro di Immunologia dei Trapianti, IRCCS Policlinico San Matteo, Pavia, Italy

    M Martinetti & L Salvaneschi

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  1. S Giebel
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Giebel, S., Giorgiani, G., Martinetti, M. et al. Low incidence of severe acute graft-versus-host disease in children given haematopoietic stem cell transplantation from unrelated donors prospectively matched for HLA class I and II alleles with high-resolution molecular typing. Bone Marrow Transplant 31, 987–993 (2003). https://doi.org/10.1038/sj.bmt.1704054

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