CD34+ selected peripheral blood Stem Cell Boost (SCB) for Poor Graft Function (PGF) or mixed chimerism in pediatric patients, after hematopoietic stem cell transplantation: Results of a retrospective multicenter study

Background PGF is historically associated with high morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Methods In this study, we report our multicenter experience on stem cell boost (SCB) for PGF, or incomplete donor engraftment, in 16 pediatric patients. D...

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Bibliographic Details
Published in:Pediatric transplantation 2021-08, Vol.25 (5), p.e13909-n/a
Main Authors: Berger, Massimo, Faraci, Maura, Saglio, Francesco, Giardino, Stefano, Ernestina Vassallo, Elena, Prete, Arcangelo, Fagioli, Franca
Format: Article
Language:English
Subjects:
Adolescent
Antigens, CD34 - immunology
CD34 antigen
Child
Child, Preschool
Chimerism
Donors
Female
Hematopoietic Stem Cell Transplantation
Hematopoietic stem cells
Histocompatibility antigen HLA
Humans
Infant
Italy
Leukemia - immunology
Leukemia - therapy
Leukopenia - immunology
Leukopenia - therapy
Male
Morbidity
Mortality
Patients
pediatric patients
Pediatrics
Peripheral blood
Retrospective Studies
stem cell boost
Stem cell transplantation
Transplantation Conditioning
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Summary:Background PGF is historically associated with high morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Methods In this study, we report our multicenter experience on stem cell boost (SCB) for PGF, or incomplete donor engraftment, in 16 pediatric patients. Donors were HLA‐matched siblings (n = 4), unrelated donors (n = 11), or haploidentical family members (n = 1). Ten patients had two‐lineage cytopenia, 5 had one‐lineage cytopenia, and 1 had poor immunological reconstitution together with a low percentage of donor cell engraftment. A median of 6.6x106 selected CD34+/Kg was infused after 194 days from allo‐HSCT (48‐607). Results In 4 out of 5 patients, one‐lineage cytopenia was resolved, while among the 10 patients with two‐lineage cytopenia, 4 resolved both cytopenia, 5 resolved one‐lineage, and one did not respond. All patients reverted their mixed chimera to full donor chimera. OS was 56%, transplant‐related mortality (TRM) 32%, and RI 12%. The main causes of failure were related to infections with 4 out of 7 deaths caused by this. Conclusions SCB may rescue over 50% of patients with PGF after allo‐HSCT. An earlier treatment may reduce the infectious complications and improve survival.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.13909