A trial of unrelated donor marrow transplantation for children with severe sickle cell disease.
2016 11 24
Journal Article
Authors:
Shenoy, S.;
Eapen, M.;
Panepinto, J.A.;
Logan, B.R.;
Wu, J.;
Abraham, A.;
Brochstein, J.;
Chaudhury, S.;
Godder, K.;
Haight, A.E.;
Kasow, K.A.;
Leung, K.;
Andreansky, M.;
Bhatia, M.;
Dalal, J.;
Haines, H.;
Jaroscak, J.;
Lazarus, H.M.;
Levine, J.E.;
Krishnamurti, L.;
Margolis, D.;
Megason, G.C.;
Yu, L.C.;
Pulsipher, M.A.;
Gersten, I.;
DiFronzo, N.;
Horowitz, M.M.;
Walters, M.C.;
Kamani, N.
Secondary:
Blood
Volume:
128
Pagination:
2561-2567
Issue:
21
PMID:
27625358
DOI:
10.1182/blood-2016-05-715870
Keywords:
Adolescent; Allografts; Anemia, Sickle Cell; Bone Marrow Transplantation; Calcineurin Inhibitors; Child; Disease-Free Survival; Female; Follow-Up Studies; Graft vs Host Disease; Humans; Male; Survival Rate; Unrelated Donors
Abstract:
Children with sickle cell disease experience organ damage, impaired quality of life, and premature mortality. Allogeneic bone marrow transplant from an HLA-matched sibling can halt disease progression but is limited by donor availability. A Blood and Marrow Transplant Clinical Trials Network (BMT CTN) phase 2 trial conducted from 2008 to 2014 enrolled 30 children aged 4 to 19 years; 29 were eligible for evaluation. The primary objective was 1-year event-free survival (EFS) after HLA allele-matched (at HLA-A, -B, -C, and -DRB1 loci) unrelated donor transplant. The conditioning regimen included alemtuzumab, fludarabine, and melphalan. Graft-versus-host disease (GVHD) prophylaxis included calcineurin inhibitor, short-course methotrexate, and methylprednisolone. Transplant indications included stroke (n = 12), transcranial Doppler velocity >200 cm/s (n = 2), ≥3 vaso-occlusive pain crises per year (n = 12), or ≥2 acute chest syndrome episodes (n = 4) in the 2 years preceding enrollment. Median follow-up was 26 months (range, 12-62 months); graft rejection was 10%. The 1- and 2-year EFS rates were 76% and 69%, respectively. The corresponding rates for overall survival were 86% and 79%. The day 100 incidence rate of grade II-IV acute GVHD was 28%, and the 1-year incidence rate of chronic GVHD was 62%; 38% classified as extensive. There were 7 GVHD-related deaths. A 34% incidence of posterior reversible encephalopathy syndrome was noted in the first 6 months. Although the 1-year EFS met the prespecified target of ≥75%, this regimen cannot be considered sufficiently safe for widespread adoption without modifications to achieve more effective GVHD prophylaxis. The BMT CTN #0601 trial was registered at www.clinicaltrials.gov as #NCT00745420.
