International Journal of Hematology and Oncology 2020, Vol 30, Num 4 Page(s): 222-229
Conditioning with TLI/ATG in Hematopoietic Stem Cell Transplantation from Haploidentical Donors with Post-transplant Cyclophosphamide in Children in a Single Center During 2015-2017

Catalina María Acevedo-HENAO1,2, Nelson Romero-ROSAS2, Estefania BELTRAN3, Eliana MANZI2,3, Alexis Antonio Franco MORENO2,4, Mayra ESTACIO3, Guillermo Potdevin STEIN1,3, Diego Medina VALENCIA2,4

1Fundación Valle del Lili, Department of Radiotherapy, Cali, COLOMBIA
2Universidad Icesi, Faculty of Health Science, Department of Medicine, Cali, COLOMBIA
3Fundación Valle del Lili, Sub Directorate of Clinical Research, Center for Clinical Research, Cali, COLOMBIA
4Fundación Valle del Lili, Pediatric Stem Cell Transplant Service, Cali, COLOMBIA

Keywords: Stem cell transplant, Thymoglobulin, Lymphatic irradiation, Child, Adolescent
Hematopoietic stem cell transplantation is a treatment alternative for some benign blood disorders. The use of nonmyeloablative conditioning with total lymphoid irradiation and anti-thymocyte globulin has decreased the incidence of acute graft-versus-host disease and can reduce the complications of total body irradiation and generate sustained chimerism. Posttransplant cyclophosphamide has also shown benefits. This is a retrospective, case-series study of pediatric patients with benign pathologies who were treated at Fundación Valle del Lili. A descriptive analysis was performed with measures of central tendency. Survival outcomes were calculated using the Kaplan-Meier estimator. Twelve patients (50% female) with benign blood disorders were included, with an average age of 8.2 ± 5.7 years. The type of donor was haploidentical in all cases; in half, the cellular source was bone marrow. Fifty percent had a diagnosis of immunodeficiencies. The average follow-up time was 28.9 months. The total lymphoid irradiation dose corresponded to a median of 750 centigrays (IQR: 400-750). Neutrophil grafting was achieved in 12/12 patients, and platelet grafting was achieved in 11/12 patients. The presentation of acute graft-versus-host disease was 58%. The transplant related mortality was 17%, and the 1-year overall survival was 83%. Conditioning with total lymphoid irradiation and anti-thymocyte globulin and the use of posttransplant cyclophosphamide is a viable alternative; however, it did not decrease the cases of acute graft-versus-host disease.