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Outcome of 69 allogeneic stem cell transplantations for Fanconi anemia using HLA-matched unrelated donors : a study on behalf of the European Group for Blood and Marrow Transplantation

Identifieur interne : 00C192 ( Main/Exploration ); précédent : 00C191; suivant : 00C193

Outcome of 69 allogeneic stem cell transplantations for Fanconi anemia using HLA-matched unrelated donors : a study on behalf of the European Group for Blood and Marrow Transplantation

Auteurs : P. Guardiola [France, Brésil, Royaume-Uni, Espagne, Pays-Bas, Italie, Belgique, Suède, Australie, Hongrie, Danemark] ; R. Pasquini ; I. Dokal ; J. J. Ortega ; M. Van Weel-Sipman ; J. C. W. Marsh ; S. E. Ball ; F. Locatelli ; C. Vermylen ; R. Skinner ; P. Ljungman ; R. Miniero ; P. J. Shaw ; G. Souillet ; M. Michallet ; A. N. Bekassy ; G. Krivan ; P. Di Bartolomeo ; C. Heilmann ; L. Zanesco ; J. Y. Cahn ; W. Arcese ; A. Bacigalupo ; E. Gluckman

Source :

RBID : Pascal:00-0139856

Descripteurs français

English descriptors

Abstract

Allogeneic stem cell transplantation is the only treatment that can restore a normal hematopoiesis in Fanconi anemia (FA). In this retrospective multicenter study, we analyzed the results of this approach using HLA-matched unrelated bone marrow donors, and tried to identify covarlates predicting the outcome of the transplant. From January 1985 to June 1998, 69 FA patients were transplanted with unrelated HLA-matched donors. Patients' characteristics before and after transplant were provided by the European group blood and marrow transplant registry and were analyzed in collaboration with the European Fanconi Anemia Registry. The 3-year probability of survival was 33%. Extensive malformatlons, a positive recipient cytomegalovirus serology, the use of androgens before transplant, and female donors were associated with a worse outcome. Primary graft failures were observed more frequently when female donors were used, mainly because the grafts contained lower nucleated cell doses per kilogram of recipient body weight compared with grafts coming from male donors. The probability of grade III-IV acute graft-versus-host disease (GVHD) was 34%. Elevated serum alanine/aspartate transaminases before transplantation; limb, urogenital tract, or nephrologic malformations ; and non-T-cell-depleted grafts were predictors of severe acute GVHD. This study shows the dramatic impact of preexisting congenital malformatlons on the outcome of FA patients transplanted with HLA-matched unrelated donors. If the use of T-cell depletion has led to a dramatic reduction of acute GVHD incidence, no significant outcome improvement was observed with this approach, mainly because of an increased risk of graft failure.


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<name sortKey="Heilmann, C" sort="Heilmann, C" uniqKey="Heilmann C" first="C." last="Heilmann">C. Heilmann</name>
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<name sortKey="Cahn, J Y" sort="Cahn, J Y" uniqKey="Cahn J" first="J. Y." last="Cahn">J. Y. Cahn</name>
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<name sortKey="Arcese, W" sort="Arcese, W" uniqKey="Arcese W" first="W." last="Arcese">W. Arcese</name>
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<name sortKey="Bacigalupo, A" sort="Bacigalupo, A" uniqKey="Bacigalupo A" first="A." last="Bacigalupo">A. Bacigalupo</name>
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<region nuts="2">Hongrie centrale</region>
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<inist:fA14 i1="17">
<s1>Department of Hematology, Ospedale Civile</s1>
<s2>Pescara</s2>
<s3>ITA</s3>
</inist:fA14>
<country>Italie</country>
<wicri:noRegion>Pescara</wicri:noRegion>
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<s1>Pediatric Clinic II, Rigshospitalet</s1>
<s2>Copenhagen</s2>
<s3>DNK</s3>
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<country>Danemark</country>
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<settlement type="city">Copenhague</settlement>
<region type="région" nuts="2">Hovedstaden</region>
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<s1>Clinics Oncoematologica Pediatrica e Centro Leucemie Infantili</s1>
<s2>Padua</s2>
<s3>ITA</s3>
</inist:fA14>
<country>Italie</country>
<wicri:noRegion>Clinics Oncoematologica Pediatrica e Centro Leucemie Infantili</wicri:noRegion>
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<s1>Department of Hematology, Hospital Jean Minjoz</s1>
<s2>Besançon</s2>
<s3>FRA</s3>
</inist:fA14>
<country>France</country>
<placeName>
<region type="region">Bourgogne-Franche-Comté</region>
<region type="old region">Franche-Comté</region>
<settlement type="city">Besançon</settlement>
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<affiliation wicri:level="3">
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<s1>GITMO - Roma, Ematologia, Universita "La Sapienza"</s1>
<s2>Rome</s2>
<s3>ITA</s3>
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<country>Italie</country>
<placeName>
<settlement type="city">Rome</settlement>
<region nuts="2">Latium</region>
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</affiliation>
<affiliation wicri:level="1">
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<s1>Department of Hematology, Ospedale San Martino</s1>
<s2>Genoa</s2>
<s3>ITA</s3>
</inist:fA14>
<country>Italie</country>
<wicri:noRegion>Genoa</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Pasquini, R" sort="Pasquini, R" uniqKey="Pasquini R" first="R." last="Pasquini">R. Pasquini</name>
</author>
<author>
<name sortKey="Dokal, I" sort="Dokal, I" uniqKey="Dokal I" first="I." last="Dokal">I. Dokal</name>
</author>
<author>
<name sortKey="Ortega, J J" sort="Ortega, J J" uniqKey="Ortega J" first="J. J." last="Ortega">J. J. Ortega</name>
</author>
<author>
<name sortKey="Van Weel Sipman, M" sort="Van Weel Sipman, M" uniqKey="Van Weel Sipman M" first="M." last="Van Weel-Sipman">M. Van Weel-Sipman</name>
</author>
<author>
<name sortKey="Marsh, J C W" sort="Marsh, J C W" uniqKey="Marsh J" first="J. C. W." last="Marsh">J. C. W. Marsh</name>
</author>
<author>
<name sortKey="Ball, S E" sort="Ball, S E" uniqKey="Ball S" first="S. E." last="Ball">S. E. Ball</name>
</author>
<author>
<name sortKey="Locatelli, F" sort="Locatelli, F" uniqKey="Locatelli F" first="F." last="Locatelli">F. Locatelli</name>
</author>
<author>
<name sortKey="Vermylen, C" sort="Vermylen, C" uniqKey="Vermylen C" first="C." last="Vermylen">C. Vermylen</name>
</author>
<author>
<name sortKey="Skinner, R" sort="Skinner, R" uniqKey="Skinner R" first="R." last="Skinner">R. Skinner</name>
</author>
<author>
<name sortKey="Ljungman, P" sort="Ljungman, P" uniqKey="Ljungman P" first="P." last="Ljungman">P. Ljungman</name>
</author>
<author>
<name sortKey="Miniero, R" sort="Miniero, R" uniqKey="Miniero R" first="R." last="Miniero">R. Miniero</name>
</author>
<author>
<name sortKey="Shaw, P J" sort="Shaw, P J" uniqKey="Shaw P" first="P. J." last="Shaw">P. J. Shaw</name>
</author>
<author>
<name sortKey="Souillet, G" sort="Souillet, G" uniqKey="Souillet G" first="G." last="Souillet">G. Souillet</name>
</author>
<author>
<name sortKey="Michallet, M" sort="Michallet, M" uniqKey="Michallet M" first="M." last="Michallet">M. Michallet</name>
</author>
<author>
<name sortKey="Bekassy, A N" sort="Bekassy, A N" uniqKey="Bekassy A" first="A. N." last="Bekassy">A. N. Bekassy</name>
</author>
<author>
<name sortKey="Krivan, G" sort="Krivan, G" uniqKey="Krivan G" first="G." last="Krivan">G. Krivan</name>
</author>
<author>
<name sortKey="Di Bartolomeo, P" sort="Di Bartolomeo, P" uniqKey="Di Bartolomeo P" first="P." last="Di Bartolomeo">P. Di Bartolomeo</name>
</author>
<author>
<name sortKey="Heilmann, C" sort="Heilmann, C" uniqKey="Heilmann C" first="C." last="Heilmann">C. Heilmann</name>
</author>
<author>
<name sortKey="Zanesco, L" sort="Zanesco, L" uniqKey="Zanesco L" first="L." last="Zanesco">L. Zanesco</name>
</author>
<author>
<name sortKey="Cahn, J Y" sort="Cahn, J Y" uniqKey="Cahn J" first="J. Y." last="Cahn">J. Y. Cahn</name>
</author>
<author>
<name sortKey="Arcese, W" sort="Arcese, W" uniqKey="Arcese W" first="W." last="Arcese">W. Arcese</name>
</author>
<author>
<name sortKey="Bacigalupo, A" sort="Bacigalupo, A" uniqKey="Bacigalupo A" first="A." last="Bacigalupo">A. Bacigalupo</name>
</author>
<author>
<name sortKey="Gluckman, E" sort="Gluckman, E" uniqKey="Gluckman E" first="E." last="Gluckman">E. Gluckman</name>
</author>
</analytic>
<series>
<title level="j" type="main">Blood</title>
<title level="j" type="abbreviated">Blood</title>
<idno type="ISSN">0006-4971</idno>
<imprint>
<date when="2000">2000</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt>
<title level="j" type="main">Blood</title>
<title level="j" type="abbreviated">Blood</title>
<idno type="ISSN">0006-4971</idno>
</seriesStmt>
</fileDesc>
<profileDesc>
<textClass>
<keywords scheme="KwdEn" xml:lang="en">
<term>Europe</term>
<term>Fanconi anemia</term>
<term>HLA-System</term>
<term>Hematopoietic cell</term>
<term>Histocompatibility</term>
<term>Homograft</term>
<term>Human</term>
<term>Stem cell</term>
<term>Treatment</term>
<term>Unrelated donor</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr">
<term>Anémie Fanconi</term>
<term>Traitement</term>
<term>Homogreffe</term>
<term>Homme</term>
<term>Cellule souche</term>
<term>Cellule hématopoïétique</term>
<term>Donneur non apparenté</term>
<term>Europe</term>
<term>Système HLA</term>
<term>Histocompatibilité</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr">
<term>Homme</term>
<term>Cellule souche</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">Allogeneic stem cell transplantation is the only treatment that can restore a normal hematopoiesis in Fanconi anemia (FA). In this retrospective multicenter study, we analyzed the results of this approach using HLA-matched unrelated bone marrow donors, and tried to identify covarlates predicting the outcome of the transplant. From January 1985 to June 1998, 69 FA patients were transplanted with unrelated HLA-matched donors. Patients' characteristics before and after transplant were provided by the European group blood and marrow transplant registry and were analyzed in collaboration with the European Fanconi Anemia Registry. The 3-year probability of survival was 33%. Extensive malformatlons, a positive recipient cytomegalovirus serology, the use of androgens before transplant, and female donors were associated with a worse outcome. Primary graft failures were observed more frequently when female donors were used, mainly because the grafts contained lower nucleated cell doses per kilogram of recipient body weight compared with grafts coming from male donors. The probability of grade III-IV acute graft-versus-host disease (GVHD) was 34%. Elevated serum alanine/aspartate transaminases before transplantation; limb, urogenital tract, or nephrologic malformations ; and non-T-cell-depleted grafts were predictors of severe acute GVHD. This study shows the dramatic impact of preexisting congenital malformatlons on the outcome of FA patients transplanted with HLA-matched unrelated donors. If the use of T-cell depletion has led to a dramatic reduction of acute GVHD incidence, no significant outcome improvement was observed with this approach, mainly because of an increased risk of graft failure.</div>
</front>
</TEI>
<affiliations>
<list>
<country>
<li>Australie</li>
<li>Belgique</li>
<li>Brésil</li>
<li>Danemark</li>
<li>Espagne</li>
<li>France</li>
<li>Hongrie</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>Suède</li>
</country>
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<li>Bourgogne-Franche-Comté</li>
<li>Catalogne</li>
<li>Franche-Comté</li>
<li>Grand Londres</li>
<li>Hollande-Méridionale</li>
<li>Hongrie centrale</li>
<li>Hovedstaden</li>
<li>Latium</li>
<li>Nouvelle-Galles du Sud</li>
<li>Piémont</li>
<li>Région de Bruxelles-Capitale</li>
<li>Île-de-France</li>
</region>
<settlement>
<li>Barcelone</li>
<li>Besançon</li>
<li>Bruxelles</li>
<li>Budapest</li>
<li>Copenhague</li>
<li>Leyde</li>
<li>Londres</li>
<li>Paris</li>
<li>Rome</li>
<li>Sydney</li>
<li>Turin</li>
</settlement>
</list>
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<name sortKey="Arcese, W" sort="Arcese, W" uniqKey="Arcese W" first="W." last="Arcese">W. Arcese</name>
<name sortKey="Bacigalupo, A" sort="Bacigalupo, A" uniqKey="Bacigalupo A" first="A." last="Bacigalupo">A. Bacigalupo</name>
<name sortKey="Ball, S E" sort="Ball, S E" uniqKey="Ball S" first="S. E." last="Ball">S. E. Ball</name>
<name sortKey="Bekassy, A N" sort="Bekassy, A N" uniqKey="Bekassy A" first="A. N." last="Bekassy">A. N. Bekassy</name>
<name sortKey="Cahn, J Y" sort="Cahn, J Y" uniqKey="Cahn J" first="J. Y." last="Cahn">J. Y. Cahn</name>
<name sortKey="Di Bartolomeo, P" sort="Di Bartolomeo, P" uniqKey="Di Bartolomeo P" first="P." last="Di Bartolomeo">P. Di Bartolomeo</name>
<name sortKey="Dokal, I" sort="Dokal, I" uniqKey="Dokal I" first="I." last="Dokal">I. Dokal</name>
<name sortKey="Gluckman, E" sort="Gluckman, E" uniqKey="Gluckman E" first="E." last="Gluckman">E. Gluckman</name>
<name sortKey="Heilmann, C" sort="Heilmann, C" uniqKey="Heilmann C" first="C." last="Heilmann">C. Heilmann</name>
<name sortKey="Krivan, G" sort="Krivan, G" uniqKey="Krivan G" first="G." last="Krivan">G. Krivan</name>
<name sortKey="Ljungman, P" sort="Ljungman, P" uniqKey="Ljungman P" first="P." last="Ljungman">P. Ljungman</name>
<name sortKey="Locatelli, F" sort="Locatelli, F" uniqKey="Locatelli F" first="F." last="Locatelli">F. Locatelli</name>
<name sortKey="Marsh, J C W" sort="Marsh, J C W" uniqKey="Marsh J" first="J. C. W." last="Marsh">J. C. W. Marsh</name>
<name sortKey="Michallet, M" sort="Michallet, M" uniqKey="Michallet M" first="M." last="Michallet">M. Michallet</name>
<name sortKey="Miniero, R" sort="Miniero, R" uniqKey="Miniero R" first="R." last="Miniero">R. Miniero</name>
<name sortKey="Ortega, J J" sort="Ortega, J J" uniqKey="Ortega J" first="J. J." last="Ortega">J. J. Ortega</name>
<name sortKey="Pasquini, R" sort="Pasquini, R" uniqKey="Pasquini R" first="R." last="Pasquini">R. Pasquini</name>
<name sortKey="Shaw, P J" sort="Shaw, P J" uniqKey="Shaw P" first="P. J." last="Shaw">P. J. Shaw</name>
<name sortKey="Skinner, R" sort="Skinner, R" uniqKey="Skinner R" first="R." last="Skinner">R. Skinner</name>
<name sortKey="Souillet, G" sort="Souillet, G" uniqKey="Souillet G" first="G." last="Souillet">G. Souillet</name>
<name sortKey="Van Weel Sipman, M" sort="Van Weel Sipman, M" uniqKey="Van Weel Sipman M" first="M." last="Van Weel-Sipman">M. Van Weel-Sipman</name>
<name sortKey="Vermylen, C" sort="Vermylen, C" uniqKey="Vermylen C" first="C." last="Vermylen">C. Vermylen</name>
<name sortKey="Zanesco, L" sort="Zanesco, L" uniqKey="Zanesco L" first="L." last="Zanesco">L. Zanesco</name>
</noCountry>
<country name="France">
<region name="Île-de-France">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
</region>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
</country>
<country name="Brésil">
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<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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<country name="Royaume-Uni">
<region name="Angleterre">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
</country>
<country name="Espagne">
<region name="Catalogne">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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</country>
<country name="Pays-Bas">
<region name="Hollande-Méridionale">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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</country>
<country name="Italie">
<noRegion>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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<region name="Région de Bruxelles-Capitale">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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<country name="Suède">
<noRegion>
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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<country name="Australie">
<region name="Nouvelle-Galles du Sud">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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</country>
<country name="Hongrie">
<region name="Hongrie centrale">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
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</country>
<country name="Danemark">
<region name="Hovedstaden">
<name sortKey="Guardiola, P" sort="Guardiola, P" uniqKey="Guardiola P" first="P." last="Guardiola">P. Guardiola</name>
</region>
</country>
</tree>
</affiliations>
</record>

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