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Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation - A comparison of the last two decades.
Oncology/Coagulation Section, Karolinska University Hospital, Stockholm, Sweden.
Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden.
Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden.
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2016 (English)In: Pediatric Transplantation, ISSN 1397-3142, E-ISSN 1399-3046, Vol. 20, no 5, p. 667-74Article in journal (Refereed) Published
Abstract [en]

Pediatric protocols for allogeneic hematopoietic SCT have been altered during the last two decades. To compare the outcomes in children (<18 yr old), who underwent SCT at our center during 1992-2002 (P1) and 2003-2013 (P2). We retrospectively analyzed 188 patients in P1 and 201 patients in P2. The most significant protocol changes during P2 compared with P1 were a decrease in MAC protocols, particularly those containing TBI, an increase in RIC protocols, and altered GvHD prophylaxis. In addition, P2 had more patients with nonmalignant diagnoses (p = 0.002), more mismatched (MM) donors (p = 0.01), and more umbilical CB grafts (p = 0.03). Mesenchymal or DSCs were used for severe acute GvHD during P2. Three-yr OS in P1 was 58%, and in P2, it was 78% (p < 0.001). Improved OS was seen in both malignant disorders (51% vs. 68%; p = 0.05) and nonmalignant disorders (77% vs. 87%; p = 0.04). Multivariate analysis showed that SCT during P2 was associated with reduced mortality (HR = 0.57; p = 0.005), reduced TRM (HR = 0.57; p = 0.03), unchanged relapse rate, similar rate of GF, less chronic GvHD (HR = 0.49; p = 0.01), and more acute GvHD (HR = 1.77, p = 0.007). During recent years, OS has improved at our center, possibly reflecting the introduction of less toxic conditioning regimens and a number of other methodological developments in SCT.

Place, publisher, year, edition, pages
2016. Vol. 20, no 5, p. 667-74
Keywords [en]
allogeneic stem cell transplantation, pediatric hematopoietic stem cell, survival
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-348258DOI: 10.1111/petr.12723PubMedID: 27251184OAI: oai:DiVA.org:uu-348258DiVA, id: diva2:1196971
Available from: 2018-04-11 Created: 2018-04-11 Last updated: 2018-04-11

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