Trasplante de progenitores hematopoyéticos de sangre de cordón umbilical en niños
- I. Badell Serra
- T. Olivé Oliveras
- L. Madero López
- Arturo Muñoz Villa
- A. Martínez Rubio
- Amparo Verdeguer Miralles
- C. Díaz de Heredia Rubio
- A. Díaz Pérez
- J. Cubells Rieró
- María Soledad Maldonado Regalado
- J.J. Ortega Aramburu
Ano de publicación: 2000
Volume: 53
Número: 6
Páxinas: 513-519
Tipo: Artigo
Obxectivos de Desenvolvemento Sustentable
Resumo
Objective Retrospective study of the outcome of cord blood trans-plantation (CBT) in children in Spain. Patients and method Twenty-eight patients (mean age 6.5 years; mean weight 25 kg) received a CBT between July 1994 and May 1998 in several centres of the Spanish Pediatric Bone Marrow Transplant Group. In 2 patients the donor was an identical human leukocyte antigen (HLA)-sibling and in two the donor was a mismatched family donor. In 24 patients the donor was unrelated, and 21 of these received an HLA-mismatched CBT. Twenty-one patients (75%) received a CBT for leukemia mainly in advanced phase. Seven patients were transplanted for genetic disease. Of these, five had congenital immunodeficiency. The conditioning treatment included total body irradiation in ten patients and combined chemotherapy in the remaining patients. In all patients graft-versus-host disease (GVHD) prophylaxis was performed with cyclosporine, and corticosteroids or methotrexate were added in patients with HLA-mismatched donors. The mean number of nucleated cells infused was 53.4×106/kg. Results Graft failure was observed in nine patients. Eighteen patients (64.3%) developed grade II-IV acute GVHD. Eight patients (28.6%) developed severe GVHD. Actuarial event-free survival (EFS) of all the patients was 34.4±69% at 3 years, with a mean followup of 16.6 months. EFS was more favorable in patients with genetic disease (71±17%) and in those with an HLA (A, B and DR) identical donor (6/6) (66±19%). Conclusions The most favorable results were obtained in patients with genetic diseases. We observed an inverse correlation between EFS and patients with HLA-identical donors. The high incidence of severe acute GVHD could have been related to a lack of accuracy in the HLA-typography of some patients.