Pediatric Allogeneic Hematopoietic Stem Cell Transplantation from Hla Partial Matched Related Donor

Most patients requiring allogeneic hematopoietic stem cell transplant ( HSCT) do not have an HLA-matched sibling donor. A phenotypically HLA- matched unrelated donor (MUD) graft has been made available for about 60% of Taiwanese. However, almost all patients have a readily available HLA- partial matched related donor (PMRD). We summarize our experience with 14 patients who ranged from 2 months to 16 years of age . They received allo- PMRD HSCT following conditioning therapy. Four of 14 patients failed to engraft. The probability of engraftment was 79.5%. Grade II to IV acute graft-versus-host disease (GVHD) was seen in 7 of 10 (70%) valuable patients. Transplant related mortality was 21% (3/ 14). Among 14 patients, 4 are surviving at a median follow- up of 94.5 months (range 52 to 117 months). The overall median survival was 4.6 months (range 0.1 to 117 months). The 5-year survival probability was 28.6% (CI,4.9-52.2%). The 5- year disease-free survival probability was 14.3% (CI,0 -32.6%). An analysis to compare patients who received a 0- or 1- antigen mismatched graft with those who received a 2- or 3- antigen mismatched graft showed no statistically significant difference in the probability of survival and disease-free survival. Though the case numbers were small and the case characteristics were not compatible in PMRD and MUD, our transplant results indicate no significant difference in engraftment, acute GVHD and survival for patients transplanted with either PMRD or MUD. A PMRD transplant can be performed with acceptable rates of graft failure and GVHD. We concluded that a PMRD graft, especial 1 -antigen disparity, is a viable option, comparable to the use of MUD, in patients with severe combined immunodeficiency disease, refractory progressive acute leukemia, time is of critical importance