Haploidic Allogeneic Transplant Of Hematopoietic Progenitors In Pediatrics In Uruguay

Introduction: allogenic hematopoietic stem cell transplantation (HSCT) is the only currently available curative treatment for a number of high-risk hematologic malignancies and for a range of inherited and acquired non-malignant diseases. Haploidentical (HI) HSCT is a valid option for patients who lack an HLA-identical brother. Objective: to describe the results obtained with HI HSCT in pediatrics. Method: in 2005 an HI HSCT program was started at the Pediatric Hemato-Oncological Department of the Centro Hospitalario Pereira Rossell, for patients who lack an HLA-matched related donor. Results: Thirty two patients were transplanted, 24 of them with hematological malignancies and 8 with non-malignant diseases. Two strategies were used to prevent the Graft-Versus-Host-Disease (GVHD), in-vitro T-cell depletion (28 patients) and in-vivo depletion of aloreactives T-cells with high-dose post-transplantation cyclophosphamide (4 patients). Successful engraftment occurred in 27 patients (84%), with full-donor chimerism. Incidence of acute and chronic GVHD was 26.9% and 11.8% respectively. One year non-relapsed mortality was 21.9%. With a median follow-up of 32 months, the overall survival was 52.4%. Conclusions: HI HSCT has proved to be a feasible option in our country for those patients without an HLA-identical donor. The results obtained are comparable to those obtained with other alternative donors and costs are more reasonable. Today, Uruguay is in a better position to offer a HSCT to patients who need it.