Successful Treatment of Stem Cell Graft Failure in Pediatric Patients Using a Submyeloablative Regimen of Campath-1H and Fludarabine

Nabil Ahmed, Kathryn S. Leung, Howard Rosenblatt, Catherine M. Bollard, Stephen Gottschalk, Gary D. Myers, George Carrum, Helen Heslop, Malcolm Brenner, Robert A. Krance

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Graft failure is a significant cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). We used a nonmyeloablative conditioning regimen consisting of the lympho-depleting humanized CD52-antibody Campath-1H and fludarabine to rescue 12 consecutive children age 9 months to 17 years with engraftment failure after initial myeloablative HSCT. Primary diagnoses included lymphohematologic malignancies (n = 6), severe combined immunodeficiency syndrome (SCID) (n = 4), and metabolic diseases (n = 2). The same stem cell donor was used as for the primary graft: mismatched family member (n = 7), matched unrelated donor (n = 4), or matched related donor (n = 1). The patients received doses of CD34+ cells that did not significantly differ from those used in the initial, failed transplant. At a median follow-up of 51 months (range, 4 to 84 months), 6 of 6 patients with nonmalignant diseases and 4 of 6 patients with malignancy were alive. Two patients died, 1 patient from pulmonary toxicity and 1 from relapse, at 51 days and 8 months posttransplantation, respectively. All 12 patients initially achieved sustained neutrophil engraftment and complete donor chimerism by day 28. Six patients received donor lymphocyte infusion (DLI) after "rescue" therapy to maintain donor chimerism. At 6 months, 4 patients had complete donor cell engraftment, 4 had 15% to 89% stable donor chimerism, and 3 had developed secondary graft failure. This conditioning regimen was generally well tolerated; 4 of the 12 patients never became neutropenic, and 9 never became thrombocytopenic. Only 1 patient developed graft-versus-host disease (GVHD; grade 1), and none had chronic GVHD. Thus, the regimen that we describe can be used with minimal toxicity to effectively overcome graft failure after myeloablative HSCT in children.

Original languageEnglish (US)
Pages (from-to)1298-1304
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume14
Issue number11
DOIs
StatePublished - Nov 2008

Keywords

  • Campath-1H
  • Graft failure
  • HSCT
  • Pediatric
  • Submyeloablative

ASJC Scopus subject areas

  • Transplantation
  • Hematology

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