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Treosulfan-based conditioning for allogeneic HSCT in children with chronic granulomatous disease: a multicenter experience

Lookup NU author(s): Professor Andrew GenneryORCiD, Dr Mary Slatter

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Abstract

Chronic granulomatous disease (CGD) can be cured by allogeneic hemopoietic stem cell transplantation (HSCT). Complications include graft failure, graft-versus-host disease (GVHD), infection, and transplant-related mortality; therefore, reduced-intensity conditioning regimens are being used to improve outcomes. In this retrospective study, the aim was to determine the outcome of treosulfan-based conditioning in HSCT for pediatric patients with CGD. The following data were collected: risk features pre-HSCT, additional conditioning agents, donor type and stem cell source, toxicity, engraftment, GVHD, chimerism, viral reactivation, post-HSCT complications, length of follow-up, and outcome. Seventy patients (median age, 107 months; interquartile range [IQR], 46-232 months) from 16 centers worldwide were transplanted between 2006 and 2015. Ninety-one percent had high-risk features. Fifty-seven HLA-matched donors, 12 HLA-mismatched donors, and 1 CD3(+)TCR alpha beta/CD19 depleted parental haploidentical transplants were performed. No major toxicity was reported. Median times to neutrophil and platelet engraftment were 17 (IQR, 15-35) and 16 (IQR, 13-50) days. At a median follow-up of 34 months (IQR, 13-102 months), the overall survival was 91.4%, and event-free survival was 81.4%. The cumulative incidence of acute grade III-IV GVHD was 12%. Nine patients developed chronic GVHD. When split cell chimerism was available, 95% or more myeloid donor chimerism was documented in 80% of surviving patients. Secondary graft failure occurred in 12% of patients. Treosulfan-containing conditioning regimens can be used safely in HSCT for children with CGD and high-risk clinical features, achieving excellent survival with high myeloid chimerism. Further studies are needed to compare with other regimens and evaluate the long-term outcome, particularly on fertility.


Publication metadata

Author(s): Morillo-Gutierrez B, Beier R, Rao K, Burroughs L, Schulz A, Ewins AM, Gibson B, Sedlacek P, Krol L, Strahm B, Zaidman I, Kalwak K, Talano JA, Woolfrey A, Fraser C, Meyts I, Muller I, Wachowiak J, Bernardo ME, Veys P, Sykora KW, Gennery AR, Slatter M

Publication type: Article

Publication status: Published

Journal: Blood

Year: 2016

Volume: 128

Issue: 3

Pages: 440-448

Online publication date: 23/05/2016

Acceptance date: 07/05/2016

ISSN (print): 0006-4971

ISSN (electronic): 1528-0020

Publisher: American Society of Hematology

URL: http://dx.doi.org/10.1182/blood-2016-03-704015

DOI: 10.1182/blood-2016-03-704015


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Funding

Funder referenceFunder name
HL122173National Institutes of Health, National Heart, Lung, and Blood Institute

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