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Low incidence of hemorrhagic cystitis following ex vivo T-cell depleted haploidentical hematopoietic cell transplantation in children

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Abstract

Hemorrhagic cystitis (HC) is a debilitating complication following allogenic hematopoietic cell transplantation (HCT). HLA disparity and T-cell depletion have been implicated as risk factors for HC. However, reports on the incidence and risk factors for HC in ex vivo T-cell depleted haploidentical HCT (haploHCT) in children are lacking. We studied 96 haploHCT procedures performed in 83 children between 2002 and 2017. Sixty-three patients were diagnosed with a malignant disease and 20 with nonmalignant disease. All but three patients with SCID underwent myelotoxic and/or lymphotoxic conditioning therapy. Grafts were CD3+ (36.5%) or TcRαβ+ (63.5%) depleted to prevent graft versus host disease (GvHD). Fourteen patients (14.6%) were diagnosed with HC; 12 (12.5%) had clinically significant stage II–IV HC. All patients with HC had BK viruria and/or viremia. Increasing age and chemotherapeutic treatment prior to conditioning were identified as risk factors for HC. Immune recovery did not significantly differ between patients with and without HC. Thus, we report a low incidence of HC in pediatric haploHCT using ex vivo T-cell depletion. The combination of a reduced toxicity conditioning regimen, and typically absent pharmaceutical post-HCT GvHD prophylaxis in our patients might have contributed to the decreased the risk of HC, despite HLA disparity.

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Acknowledgements

This work was supported by generous grants from the Swedish Pediatric Childhood Cancer Foundation, the Scania University Hospital Foundation. The Knut and Alice Wallenberg foundation, the Medical Faculty at Lund University and Region Skåne are also acknowledged for generous financial support.

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  1. These authors contributed equally: Caroline Jepsen and Dominik Turkiewicz

Authors and Affiliations

  1. Department of Pediatric Oncology and Hematology, University Hospital Gothenburg, Gothenburg, Sweden

    Caroline Jepsen & Karin Mellgren

  2. Department of Pediatric Oncology and Hematology, Skåne University Hospital, Lund, Sweden

    Dominik Turkiewicz, Jacek Toporski & Cornelis Jan Pronk

  3. University Hospital Pediatric clinic II, Copenhagen University Hospital, Copenhagen, Denmark

    Marianne Ifversen & Carsten Heilmann

  4. Department of Immunology and Transfusion Medicine, University Hospital in Scania, Lund, Sweden

    Josefina Dykes

  5. Wallenberg Center for Molecular Medicine and Division of Molecular Hematology, Lund University, Lund, Sweden

    Cornelis Jan Pronk

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  1. Caroline Jepsen
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  2. Dominik Turkiewicz
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Correspondence to Dominik Turkiewicz.

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Jepsen, C., Turkiewicz, D., Ifversen, M. et al. Low incidence of hemorrhagic cystitis following ex vivo T-cell depleted haploidentical hematopoietic cell transplantation in children. Bone Marrow Transplant 55, 207–214 (2020). https://doi.org/10.1038/s41409-019-0672-4

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