Outcomes of hematopoietic stem cell transplantation in 813 pediatric patients with Fanconi anemia
Su Han Lum, Dirk-Jan Eikema, Brian Piepenbroek, Robert Wynn, Sujith Samarasinghe, Arnaud Dalissier, Krzysztof Kałwak, Mouhab Ayas, Rose-Marie Hamladji, M. Akif Yeşilipek, Jean‐Hugues Dalle, Duygu Uçkan, Marc Bierings, Alphan Küpesiz, Khalid Halahleh, Е. В. Скоробогатова, Gülyüz Öztürk, Maura Faraci, C. Rénard, Pamela Evans, Selim Corbacioglu, Franco Locatelli, Carlo Dufour, Antonio M. Risitano, Régis Peffault de Latour
Abstract
ABSTRACT: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only established curative option for Fanconi anemia (FA)-associated bone marrow failure (BMF)/aplastic anemia (AA) and acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS). We performed a retrospective multicenter study on 813 children with FA undergoing first HSCT between 2010 and 2018. Median duration of follow-up was 3.7 years. Median age at transplant was 8.8 years (IQR, 6.5-18.1). Five-year overall survival (OS), event-free survival (EFS), and graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) were 83% (95% confidence interval [CI], 80-86), 78% (95% CI, 75-81), and 70% (95% CI, 67-74), respectively. OS was comparable between matched family donor (MFD; n = 441, 88%) and matched unrelated donor (MUD; n = 162, 86%) and was superior to that of mismatched family donor (MMFD) or mismatched unrelated donor (MMUD; n = 144, 72%) and haploidentical donor (HID; n = 66, 70%; P < .001). In multivariable analysis, a transplant indication of AML/MDS (vs AA/BMF), use of MMFD/MMUD and HID (vs MFD), and fludarabine-cyclophosphamide (FluCy) plus other conditioning (vs FluCy) independently predicted inferior OS, whereas alemtuzumab vs antithymocyte globulin was associated with better OS. Age ≥10 years was associated with worse EFS and GRFS. Cumulative incidences (CINs) of primary and secondary graft failure were 2% and 3% respectively. CINs of grade 3 to 4 acute GVHD and chronic GVHD were 12% and 8% respectively. The 5-year CIN of secondary malignancy was 2%. These data suggest that HSCT should be offered to patients with FA with AA/BMF at a younger age in the presence of a well-matched donor.