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Haploidentical Stem Cell Transplantation in Children with Benign Disorders: Improved Survival and Cost-Effective Care Over 15 Years from a Single Center in India

  • Ramya UppuluriEmail author
  • Meena Sivasankaran
  • Shivani Patel
  • Venkateswaran Vellaichamy Swaminathan
  • Nikila Ravichandran
  • Kesavan Melarcode Ramanan
  • Lakshman Vaidhyanathan
  • Balasubramaniam Ramakrishnan
  • Indira Jayakumar
  • Revathi Raj
Original Article
  • 6 Downloads

Abstract

We present our experience in haploidentical stem cell transplantation (haplo SCT) in children with benign disorders. We performed a retrospective study where children aged up to 18 years diagnosed to have benign disorders and underwent haplo SCT from 2002 to September 2017 were included. Of the 54 children, the most common indications were Fanconi anaemia 12 (22%), severe aplastic anaemia 8 (14%) and primary immune deficiency disorders (PID) 25 (46%). Post-transplant cyclophosphamide (PTCy) was used in 41 (75.9%) and ex vivo T depletion in 13 (24.1%). Engraftment rates were 70% with acute graft versus host disease in 36% and cytomegalovirus reactivation in 55% children. There was a statistically significant difference found between survival with siblings as donors as compared to parents (p value 0.018). Overall survival was 60% which is the 1-year survival, with 68% survival among those with PIDs. Cytokine release syndrome was noted in 12/41 (29%) of children who received T replete graft and PTCy. In children over 6 months of age, PTCy at a cost of INR 1200 provides cost effective T cell depletion comparable with TCR α/β depletion priced at INR 1200,000. Haplo SCT is feasible option for cure in children with benign disorder.

Keywords

Haploidentical stem cell transplantation Benign disorders Children 

Notes

Acknowledgements

We would like to acknowledge the immense support provided by the paediatric critical care team and the infectious disease specialists in the management of these children.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Indian Society of Hematology and Blood Transfusion 2019

Authors and Affiliations

  • Ramya Uppuluri
    • 1
    Email author
  • Meena Sivasankaran
    • 1
  • Shivani Patel
    • 1
  • Venkateswaran Vellaichamy Swaminathan
    • 1
  • Nikila Ravichandran
    • 1
  • Kesavan Melarcode Ramanan
    • 1
  • Lakshman Vaidhyanathan
    • 2
  • Balasubramaniam Ramakrishnan
    • 1
  • Indira Jayakumar
    • 3
  • Revathi Raj
    • 1
  1. 1.Department of Pediatric Hematology, Oncology, Blood and Marrow TransplantationApollo Cancer InstitutesChennaiIndia
  2. 2.Department of HematologyApollo Cancer InstitutesChennaiIndia
  3. 3.Department of Pediatric Critical CareApollo Cancer InstitutesChennaiIndia

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