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Pediatric Transplants

Multiple BM harvests in pediatric donors for thalassemic siblings: safety, efficacy and ethical issues

Bone Marrow Transplantation volume 42, pages 379–384 (2008)Cite this article

Abstract

Allogeneic BMT represents the only chance of cure for β-thalassemia. Occasionally, two affected individuals from the same family share a matched healthy sibling. Moreover, a high incidence of transplant rejection is still observed in Pesaro class III patients, requiring a second BMT procedure. In these settings, one option is to perform a second BM harvest from the same donor. Although BM harvest is a safe procedure in children, ethical issues concerning this invasive practice still arise. Here, we describe our series of seven pediatric, healthy donors, who donated BM more than once in favor of their β-thalassemic HLA-identical siblings between June 2005 and January 2008. Three donors donated BM twice to two affected siblings and four donors donated twice for the same sibling following graft rejection of the first BMT. All donors tolerated the procedures well and no relevant side effects occurred. There was no significant difference between the two harvests concerning cell yield and time to engraftment. Our experience shows that for pediatric donors, a second BM donation is safe and feasible and good cellularity can be obtained. We suggest that a second harvest of a pediatric donor can be performed when a strong indication for BMT exists.

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References

  1. Orkin SH, Nathan DG . The thalassemias. In: Nathan DG, Ginsburg D, Orkin SH, Look AT (eds). Nathan and Oski's Hematology of Infancy and Childhood, 6th edn. WB Saunders Inc: Philadelphia, PA, 2003, pp 842–919.

    Google Scholar 

  2. Vichinsky E (ed). Cooley's Anemia: Eighth Symposium. Ann N Y Acad Sci 2005; 1054, pp 526.

    Google Scholar 

  3. Lucarelli G, Clift RA . Marrow transplantation in thalassemia. In: Blume KG, Forman SJ, Appelbaum FR (eds). Thomas’ Hematopoietic Cell Transplantation, 3rd edn. Blackwell Publishing Ltd: Malden, MA, 2004, pp 1409–1416.

    Google Scholar 

  4. Lucarelli G, Angelucci E . Allogeneic hematopoietic stem cell transplantation for thalassemia. In: Atkinson K, Champlin R, Ritz J, Fibbe WE, Ljungman P, Brenner MK (eds). Clinical bone marrow and blood stem cell transplantation, 3rd edn. Cambridge University Press: Cambridge, 2004, pp 929–946.

    Google Scholar 

  5. Lucarelli G, Galimberti M . Marrow transplantation in patients with thalassemia responsive to iron chelation therapy. N Engl J Med 1993; 329: 840–844.

    Article  CAS  PubMed  Google Scholar 

  6. Zimring JC, Hair GA, Deshpande SS, Horan JT . Immunization to minor histocompatibility antigens on transfused RBCs through crosspriming into recipient MHC class I pathways. Blood 2006; 107: 187–189.

    Article  CAS  PubMed  Google Scholar 

  7. Marktel S, Chiesa R, Cappelli B, Roccia T, Biral E, Calzi E et al. Intensified immunosuppression with ATG reduces graft rejection in class III beta thalassemia patients undergoing BMT from HLA identical siblings after myeloablative conditioning. Bone Marrow Transplant 2008; 41 (Suppl 1): S177 (abstract 656).

    Google Scholar 

  8. Buckner CD, Clift RA, Sanders JE, Stewart P, Bensinger WI, Doney KC et al. Marrow harvesting from normal donors. Blood 1984; 64: 630–634.

    CAS  PubMed  Google Scholar 

  9. Sanders J, Buckner CD, Bensinger WI, Levy W, Chard R, Thomas ED . Experience with marrow harvesting from donors less than 2 years of age. Bone Marrow Transplant 1987; 2: 45–50.

    CAS  PubMed  Google Scholar 

  10. Styczynski J, Elarouci N, Labopin M, Dini G, for the Pediatric Diseases Working Party of EBMT. Allogeneic sibling donor complications of haematopoietic progenitor cell collection in children: A Multi-institutional Survey of the PDWP-EBMT Group. Bone Marrow Transplant 2008; 41 (Suppl 1): S35 (abstract 233).

    Google Scholar 

  11. http://www.fondazioneime.org.

  12. Lucarelli G, Galimberti M, Polchi P, Angelucci E, Baronciani D, Giardini C et al. Bone marrow transplantation in patients with thalassemia. NEJM 1990; 322: 417–421.

    Article  CAS  PubMed  Google Scholar 

  13. Lucarelli G, Andreani M, Angelucci E . The cure of thalassemia by bone marrow transplantation. Blood Rev 2002; 16: 81–85.

    Article  CAS  PubMed  Google Scholar 

  14. Sodani P, Gaziev D, Polchi P, Erer B, Giardini C, Angelucci E et al. New approach for bone marrow transplantation in patients with class 3 thalassemia aged younger than 17 years. Blood 2004; 104: 1201–1203.

    Article  CAS  PubMed  Google Scholar 

  15. Shama WI . The experience and preparation of pediatric sibling bone marrow donors. Soc Work Health Care 1998; 27: 89–99.

    Article  CAS  PubMed  Google Scholar 

  16. Weisz V, Robbennolt JK . Risks and benefits of pediatric bone marrow donation: a critical need for research. Behav Sci Law 1996; 14: 375–391.

    Article  CAS  PubMed  Google Scholar 

  17. Chan KW, Gajewski JL, Supkis D, Pentz R, Champlin R, Bleyer WA . Use of minors as bone marrow donors: current attitude and management. A survey of 56 pediatric transplantation centers. J Pediatr 1996; 128: 513–516.

    Article  Google Scholar 

  18. Massimo L . Ethical problems in bone marrow transplantation in children. Bone Marrow Transplant 1996; 18 (Suppl 2): 8–12.

    PubMed  Google Scholar 

  19. Barfield R, Kodish E . Ethical considerations in pediatric hematopoietic stem cell transplantation. In: Kline RM (ed). Pediatric Hematopoietic Stem Cell Transplantation. Informa Healthcare: New York, NY, 2006, pp 251–270.

    Chapter  Google Scholar 

  20. Rosenberg PS, Alter BP, Bolyard AA, Bonilla MA, Boxer LA, Cham B et al. The incidence of leukaemia and mortality from sepsis in patients with severe congenital neutropenia receiving long-term G-CSF therapy. Blood 2006; 107: 4628–4635.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. La Nasa G, Argiolu F, Giardini C, Pession A, Fagioli F, Caocci G et al. Unrelated bone marrow transplantation for beta-thalassemia patients: the experience of the Italian Bone Marrow Transplant Group. Ann N Y Acad Sci 2005; 1054: 186–195.

    Article  PubMed  Google Scholar 

  22. Bortin MM, Buckner CD . Major complications of marrow harvesting for transplantation. Exp Hematol 1983; 11: 916–921.

    CAS  PubMed  Google Scholar 

  23. Stroncek D, Holland P . Experience of the first 493 unrelated marrow donors in the national marrow donor program. Blood 1993; 81: 1940–1946.

    CAS  PubMed  Google Scholar 

  24. Favre G, Bassac M . Differences between graft product and donor side effects following bone marrow or stem cell donation. Bone Marrow Transplant 2003; 32: 873–880.

    Article  CAS  PubMed  Google Scholar 

  25. Martinez AM, Sastre A, Munoz A, Badell I, Maldonado MS, Cubells J . Recombinant human erythropoietin (rh-EPO) administration to normal child bone marrow donors. Bone Marrow Transplant 1998; 22: 137–138.

    Article  CAS  PubMed  Google Scholar 

  26. Kletzel M, Olszewski M, Danner-Koptik K, Coyne K, Haut PR . Red cell salvage and reinfusion in pediatric bone marrow donors. Bone Marrow Transplant 1999; 24: 385–388.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We are grateful to Dr Roberto Crocchiolo for statistical analysis.

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Authors and Affiliations

  1. Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute H S Raffaele, Milan, Italy

    E Biral, R Chiesa, B Cappelli, T Roccia, I Frugnoli, A Noè, C Soliman, R Fiori, L Cursi, F Cattaneo, C Evangelio, R Miniero, F Ciceri, M G Roncarolo & S Marktel

  2. San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), Milan, Italy

    C Soliman, R Miniero & M G Roncarolo

  3. Vita-Salute San Raffaele University Medical School, Milan, Italy

    M G Roncarolo

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  1. E Biral
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  5. I Frugnoli
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  13. F Ciceri
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  14. M G Roncarolo
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  15. S Marktel
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Correspondence to M G Roncarolo.

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Biral, E., Chiesa, R., Cappelli, B. et al. Multiple BM harvests in pediatric donors for thalassemic siblings: safety, efficacy and ethical issues. Bone Marrow Transplant 42, 379–384 (2008). https://doi.org/10.1038/bmt.2008.177

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  • DOI: https://doi.org/10.1038/bmt.2008.177

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