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Myeloablative MSD-SCT for SCA: long-term outcome
transplant, CD3+ chimerism was significantly lower than CD3– and whole blood donor cell chimerism, but was similar thereafter.
Long-term outcome of chimerism
One-hundred and twelve patients remained stable with donor chimerism >70% at last visit. However, one girl with a rare erythroid group (U-), transplanted in 2000
from her brother's CB (U+), had full donor chimerism at one and two years that remained stable for five years, but decreased thereafter with the appearance of hemolytic anemia. The patient was given donor lymphocyte infu- sions (DLI), which allowed the reversion to full donor chimerism along with anemia and hemolysis correction, but it induced cGvHD which was responsible for chronic pulmonary disease (currently well under control).
A
BC
Figure 3. Relationship of graft-versus-host disease (GvHD) and donor/recipient (D/R) cytomegalovirus (CMV) status, anti-thymocyte globulin (ATG) dose and recip- ient age. (A) Acute GvHD according to the D/R CMV status. Cumulative incidence of acute-GvHD at day 100 according to the D/R CMV status. (B) Chronic GvHD according to the ATG dose. Cumulative incidence of chronic GvHD at five years was significantly lower in the patients having received the high dose of ATG (20 mg/kg) (5.4%, 95%CI: 1.8-9.0%) versus those not prepared with ATG (25%, 95%CI: 5.6-44.4%) and those having received lower doses (5-15 mg/kg): 27.0%, 95%CI: 12.4- 41.6%) (Log Rank P<0.001). (C) Chronic graft-versus-host disease (GvHD) according to recipient age at transplant. Cumulative incidence of chronic GvHD in children under 15 years of age was 7.6% (95%CI: 3.8-11.4%) versus 29.7% (95%CI: 13.1-46.3%) in those older than 15.
Table 3. Rejection, transplant-related mortality, event-free survival as a function of the cell source, bone marrow (BM) versus cord blood (CB) alone.
CB alone (n=30)
2
Late rejection
Cumulative Incidence of rejection at 5 years (including non-engraftment)
Deaths 0 Events 2
BM (n=195) P
Non-engraftment (n)
0
0.017
0
6.7% ± 9.2%
6 NS 2.7% ± 2.4% NS 7 NS 13 NS 93.7% ± 3.6% NS 21.1% ± 5.8% NS 11% ± 4.6% NS 84.5% ± 5.2% NS
EFS at 5 years
Cumulative Incidence of acute GVHD ≥ grade II Cumulative Incidence of chronic-GVHD
EFS chronic-GVHD free at 5 years
93.3% ± 9.2% 13.3% ± 12.4% 3.3% ± 6.6% 90.0% ± 10.1%
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