Effectiveness of T-Cell Replete Haploidentical Hematopoietic Stem Cell Transplantation for Refractory/Relapsed B Cell Acute Lymphoblastic Leukemia in Children and Adolescents

• DOI: 10.3389/fped.2021.743294
• Publication Date: 2021-10-13T18:29:02Z
• Authors: Hideki Sano; Kazuhiro Mochizuki; Shogo Kobayashi; Yoshihiro Ohara; Nobuhisa Takahashi; Shingo Kudo; Tomoko Waragai; Kazuhiko Ikeda; Hitoshi Ohto; Atsushi Kikuta
• Keywords: Thymoglobulin; Total body irradiation; Refractory (planetary science)

Background: The prognosis of refractory/relapsed B-cell precursor acute lymphoblastic leukemia (BCP-ALL) remains dismal owing to acquired resistance chemotherapeutic agents. This study aimed evaluate the efficacy T-cell replete HLA haploidentical hematopoietic stem cell transplantation (TCR-haplo-HSCT) for pediatric BCP-ALL (RR-BCP-ALL). Methods: Nineteen patients with RR-BCP-ALL underwent TCR-haplo-HSCT between 2010 and 2019 at Fukushima Medical University Hospital. disease status included complete remission (CR) in eight non-CR active 11 patients. Total body irradiation-based, busulfan-based, reduced-intensity conditioning regimens were employed 11, 6, 2 patients, respectively. Low-dose anti-thymocyte globulin (thymoglobulin, 2.5 mg/kg) was used all Graft-vs.-host (GVHD) prophylaxis administered tacrolimus, methotrexate, prednisolone. Results: All received peripheral blood cells as source. disparities graft vs. host directions 2/8 one, 3/8 five, 4/8 13 Among 18 who achieved primary engraftment, GVHD occurred evaluable (grade II, 9; grade III, 8; IV, 1), chronic observed 10 out 15 Three died because transplant-related mortality. 3-year overall survival (OS) leukemia-free rates 57.4 42.1%, Compared older than years age (N = 10), those younger 9) showed an excellent OS rate (3-year rate: < old, 100%; > 20% [95% confidence interval, 3.1-47.5]; p 0.002). Conclusions: We suggest that TCR haplo-HSCT low-dose ATG has potential improve outcomes RR-BCP.