Allogeneic PBPC transplantation in children

While PBPC are being used increasingly as a source of stem cells in allotransplantation, the published experience in pediatric donor-recipient pairs is limited. Our aim was to evaluate the mobilization of PBPC in healthy child donors and the outcome of child recipients undergoing allogeneic PBSC transplant.

Eight children with malignancies AML (one), refractory anemia with excess blasts in transformation (RAEBt) (one), ALL (four), NHL (one) and neuroblastoma (one)] were grafted with PBPC from HLA-identical sibling donors (seven patients) or from a 2-antigen mismatched donor (one case). Donors, aged 1-15 years underwent leukapheresis after mobilization with G-CSF (10-15 g/kg/day, 4 days). The extracorporeal line was primed in five cases (four with HSA). Peripheral venous access was used in all except one infant. The harvests were cryopreserved in six cases. GvHD prophylaxis consisted of CsA plus MTX or methylprednisolone.

No adverse effects related to G-CSF administration, nor procedure-related complications were observed. Median number of CD34(+) cells harvested was 5.18 x 10(6)/kg (range, 2.56-6.40), after one (five cases) or two (three cases) leukaphereses. All patients engrafted. The median time to achieve an ANC > 0.5 x 10(9)/L was 11 days (range 9-13) and a platelet count of > 50 x 10(9)/L was 18 days (range 13-45). Six patients did not develop any acute GvHD and three developed chronic GvHD. After a median follow-up of 18 months (14-44 months), six patients are alive and five in complete remission.

Allogeneic PBPC transplantation has shown to be a safe and successful procedure for pediatric donor and recipient pairs.