Enzyme replacement therapy prior to haematopoietic stem cell transplantation in Mucopolysaccharidosis Type I: 10 year combined experience of 2 centres

• Published in: Molecular genetics and metabolism 2016-03, Vol.117 (3), p.373-377
• Main Authors: Ghosh, Arunabha, Miller, Weston, Orchard, Paul J, Jones, Simon A, Mercer, Jean, Church, Heather J, Tylee, Karen, Lund, Troy, Bigger, Brian W, Tolar, Jakub, Wynn, Robert F
• Format: Article
• Language: English
• Subjects: Child, Preschool; Enzyme Replacement Therapy; Female; Follow-Up Studies; Glycosaminoglycans - urine; Graft vs Host Disease - diagnosis; Graft vs Host Disease - etiology; Hematopoietic Stem Cell Transplantation; Humans; Iduronidase - administration & dosage; Infant; Male; Mucopolysaccharidosis I - therapy; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 1096-7192; 1096-7206
• DOI: 10.1016/j.ymgme.2016.01.011

Haematopoietic stem cell transplantation is the treatment of choice for the severe form of Mucopolysaccharidosis Type I, or Hurler syndrome. In many centres standard practice is to deliver enzyme replacement therapy alongside haematopoietic stem cell transplantation to improve the condition of the patient prior to transplant. We report the combined 10 year experience of this approach in two paediatric metabolic and transplant centres. Of 81 patients who underwent a first transplant procedure for Hurler, 88% (71/81) survived and 81% (66/81) were alive and engrafted at a median follow-up of 46 months (range 3-124 months). The incidence of grade II-IV acute and any chronic graft versus host disease was 17% and 11% respectively. Urinary glycosaminoglycans were significantly reduced after a period of enzyme replacement therapy, and further reductions were seen at 13-24 months and 25+months after transplantation. In several individuals with decreased cardiac contractility, an improvement of their condition during enzyme replacement therapy enabled them to undergo transplantation, with one individual receiving full intensity conditioning.