Program of Hematopoietic Stem Cell Transplantation in Children at Department of Pediatric Hematology and Oncology, University Hospital Motol - from Fetal Liver to Cord Blood
Abstract
Objectives: Transplantation of allogeneic stem cells from healthy donor can cure several malignant and non-malignant disorders in children. In this paper authors evaluate results of allogeneic SCT (stem cell transplantation) in children performed at transplant center from November, 1989, to December, 2005.
At certain time points they determine survival rates, death rates due to toxicity or relapse of malignancy, changes in donors and grafts composition. Patients and methods: From 1989 till 2005 altogether 265 patients at the age of 0.2-20.5 years (median 9.7) underwent first allogeneic SCT at transplant unit (Teaching Hospital Motol, Prague). 71% (n=189) were transplanted for malignant disease (acute leukemia, myelodysplastic syndrome, chronic myelogenous leukemia, lymphoma, etc.), other for life-threatening non-malignant disorder (congenital or acquired bone marrow failure, severe immunodeficiency, osteopetrosis, mucopolysaccharidosis type I., adrenoleukodystrophy, etc.).
At the beginning matched sibling donors were predominantly used (81%). Bone marrow was used as a source of stem cells in majority of patients (93%).
Over last period authors use more frequently graft obtained from unrelated donor (68%), bone marrow is currently used in only 58% of transplants. Results: Out of 265 transplanted patients 165 (62%) survive.
The survival is higher in the group of children transplanted for non-malignant disorder (80% versus 55%). Over the time the authors successfully reduced overall transplant related mortality from 29% to 9%.
Survival rate improved markedly from 46% (1989-2000) to 80% (2001-2005). Conclusions: Allogeneic SCT at the transplant unit over the passed years became a standard procedure in the therapy of advanced stages of malignant diseases or some life-threatening non-malignant disorders for children from all the Czech Republic.