A Trial of Unrelated Donor Marrow Transplantation for Children with Severe Sickle Cell Disease

Publication Type
Journal Article
Year of Publication
2016
Authors
Shenoy, S; Eapen, M; Panepinto, JA; Logan, BR; Wu, J; Abraham, A; Brochstein, J; Chaudhury, S; Godder, K; Haight, AE; Kasow, KA; Leung, K; Andreansky, M; Bhatia, M; Dalal, J; Haines, H; Jaroscak, J; Lazarus, HM; Levine, JE; Krishnamurti, L; Margolis, D; Megason, GC; Yu, LC; Pulsipher, MA; Gersten, I; DiFronzo, N; Horowitz, MM; Walters, MC; Kamani, N
Secondary
Blood
Volume
128
Start Page
2561
Pagination
2561-2567
Date Published
11/2016
Keywords
Allogeneic bone marrow transplant; graft-versus-host disease (GVHD)
Abstract

Children with sickle cell disease experience organ damage, impaired quality of life, and premature mortality. Allogeneic bone marrow transplant from an HLA-matched sibling can halt disease progression but is limited by donor availability. A Blood and Marrow Transplant Clinical Trials Network (BMT CTN) phase 2 trial conducted from 2008 to 2014 enrolled 30 children aged 4 to 19 years; 29 were eligible for evaluation. The primary objective was 1-year event-free survival (EFS) after HLA allele-matched (at HLA-A, -B, -C, and -DRB1 loci) unrelated donor transplant. The conditioning regimen included alemtuzumab, fludarabine, and melphalan. Graft-versus-host disease (GVHD) prophylaxis included calcineurin inhibitor, short-course methotrexate, and methylprednisolone. Transplant indications included stroke (n = 12), transcranial Doppler velocity >200 cm/s (n = 2), ≥3 vaso-occlusive pain crises per year (n = 12), or ≥2 acute chest syndrome episodes (n = 4) in the 2 years preceding enrollment. Median follow-up was 26 months (range, 12-62 months); graft rejection was 10%. The 1- and 2-year EFS rates were 76% and 69%, respectively. The corresponding rates for overall survival were 86% and 79%. The day 100 incidence rate of grade II-IV acute GVHD was 28%, and the 1-year incidence rate of chronic GVHD was 62%; 38% classified as extensive. There were 7 GVHD-related deaths. A 34% incidence of posterior reversible encephalopathy syndrome was noted in the first 6 months. Although the 1-year EFS met the prespecified target of ≥75%, this regimen cannot be considered sufficiently safe for widespread adoption without modifications to achieve more effective GVHD prophylaxis. The BMT CTN #0601 trial was registered at www.clinicaltrials.gov as #NCT00745420.