Haploidentical allogeneic hematopoietic transplant of hematopoietic parents in pediatrics in Uruguay
Keywords:
HOMOLOGOUS TRANSPLANTATION, HAPLOIDE, HEMATOPOIETIC STEM CELLSAbstract
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.
References
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(3) Gatti RA, Meuwissen HJ, Allen HD, Hong R, Good RA. Immunological reconstitution of sex-linked lymphopenic immunological deficiency. Lancet 1968; 2(7583):1366-9 .
(4) Eapen M, Rubinstein P, Zhang MJ, Camitta BM, Stevens C, Cairo MS et al. Comparable long-term survival after unrelated and HLA matched sibling donor hematopoietic stem cell transplantations for acute leukemia in children younger than 18 months. J Clin Oncol 2006; 24(1):145-51 .
(5) Dahlke J, Kroger N, Zabelina T, Ayuk F, Fehse N, Wolschke C et al. Comparable results in patients with acute lymphoblastic leukemia after related and unrelated stem cell transplantation. Bone Marrow Transplant 2006; 37(2): 155-63.
(6) Eapen M, Rubinstein P, Zhang MJ, Stevens C, Kurtzberg J, Scaradavou A et al. Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukemia: a comparison study. Lancet 2007; 369(9577):1947-54.
(7) Klingebiel T, Cornish J, Labopin M, Locatelli F, Darbyshire P, Handgretinger R et al. Results and factors influencing outcome after fully haploidentical hematopoietic stem cell transplantation in children with very high-risk acute lymphoblastic leukemia: impact of center size. An analysis on behalf of the Acute Leukemia and Pediatric Disease Working Parties of the European Blood and Marrow Transplant group. Blood 2010; 115(17):3437-46.
(8) Hough R, Cooper N, Veys P. Allogeneic haemopoietic stem cell transplantation in children: what alternative donor should we choose when no matched sibling is available? Br J Haematol 2009; 147(5):593-613.
(9) Rocha V, Locatelli F. Searching for alternative hematopoietic stem cell donors for pediatric patients. Bone Marrow Transplant 2008; 41(2):207-14.
(10) Ballen KK, Koreth J, Chen YB, Dey BR, Spitzer TR. Selection of optimal alternative graft source: mismatched unrelated donor, umbilical cord blood, or haploidentical transplant. Blood 2012; 119(9):1972-80.
(11) Zuckerman T, Rowe JM. Alternative donor transplantation in acute myeloid leukemia: which source and when? Curr Opin Hematol 2007; 14(2):152-61.
(12) Powles RL, Morgenstern GR, Kay HE, McElwain TJ, Clink HM, Dady PJ et al. Mismatched family donors for bone-marrow transplantation as treatment for acute leukemia. Lancet 1983; 1(8325):612-5.
(13) Dufort y Alvarez G, Castiglioni M, Pagés C, Dabezies A, Decaro J, Castillo L. Trasplante de progenitores hematopoyéticos en pediatría: 10 años de experiencia. Arch Pediatr Urug 2008; 79(3):201-9.
(14) Castillo LA, Fluchel M, Dabezies A, Pieri D, Brockhorst N, Barr R. Childhood cancer in Uruguay: 1992-1994. Incidence and mortality. Med Pediatr Oncol 2001; 37(4):400-4.
(15) Barker J, Krepski, TP, DeFor TE, Davies SM, Wagner JE, Weisdorf DJ. Searching for unrelated donor hematopoietic stem cells: availability and speed of umbilical cord blood versus bone marrow. Biol Blood Marrow Transplant 2002; 8(5):257-60.
(16) Grewal SS, Barker JN, Davies SM, Wagner JE. Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood? Blood 2003; 101(11):4233-44.
(17) Fondo Nacional de Recursos. Trasplante de Médula Ósea o Trasplante de Progenitores Hematopoyéticos: normativa de cobertura del Fondo Nacional de Recursos. Montevideo: FNR, 2006.Disponible en: http://www.fnr.gub.uy /sites/default/files/normativas/tecnicas/n_tmo_0.pdf Consulta: 12 dic. 2012.
(18) Stern M, Ruggeri L, Mancusi A, Bernardo ME, de Angelis C, Bucher C et al. Survival after T cell-depleted haploidentical stem cell transplantation is improved using the mother as donor. Blood 2008; 112(7):2990-5.
(19) Leuner S, Arland M, Kahl C, Jentsch-Ullrich K, Franke A, Hoffkes HG. Enumeration of CD34-positive hematopoietic progenitor cells by flow cytometry: comparison of a volumetric assay and the ISHAGE gating strategy. Bone Marrow Transplant 1998; 22(7):699-70.
(20) Dykes JH, Toporski J, Juliusson G, Békássy AN, Lenhoff S, Lindmark A et al. Rapid and effective CD3 T-cell depletion with a magnetic cell sorting program to produce peripheral blood progenitor cell products for haploidentical transplantation in children and adults. Transfusion 2007; 47:2134-42.
(21) Schumm M, Lang P, Taylor G, Kuci S, Klingebiel T, Buhring HJ et al. Isolation of highly purified autologous and allogeneic peripheral CD34+ cells using the CliniMACS device. J Hematother 1999; 8:209-18.
(22) European Society for Blood and Marrow Transplantation. Osteopetrosis: consensus guidelines for diagnosis, therapy and follow up. Disponible en: htpp: //www.ebmt.org/Contents/About-EBMT/Who-We-Are/Workingparties/Documents/00_OP_ Guidelines_02122011.pdf Consulta: 12 dic 2012
(23) Sullivan KM. Graft-versus-host-disease. In: Blume KG, Forman SJ, Appelbaum FR, editors. Thomas’ Hematopoietic Cell Transplantation. Blackwell Science Ltd., 2004:635-64
(24) Kaplan E, Meier P. Nonparametric estimation from incomplete observations. Journal of the American Statistical Association 1958; 84:360-72 .
(25) Murphy SB. The national impact of clinical cooperative group trials for pediatric cancer. Med Pediatr Oncol 1995.
(26) Handgretinger R, Chen X, Pfeiffer M, Mueller I, Feuchtinger T, Hale GA et al. Feasability and outcome of reduced intensity conditioning in haploidentical transplantation. Ann NY Acad Sci 2007; 1106:279-89.
(27) Dufort G, Pisano S, Incoronato A, Castiglioni M, Pages C, Simon E et al. Feasibility and outcome of haploidentical SCT in pediatric high-risk hematologic malignancies and Fanconi anemia in Uruguay. Bone Marrow Transplant 2012; 47(5):663-8.
(28) Handgretinger R., Klingebiel T, Lang P, Schumm M, Neu S, Geiselhart A et al. Megadose transplantation of purified peripheral blood CD34(+) progenitor cells from HLA-mismatched parental donors in children. Bone Marrow Transplant 2001; 27:777-83.
(29) Gordon PR, Leimig T, Mueller I, Babarin-Dorner A, Holladay MA, Houston J et al. A large-scale method for T cell depletion: towards graft engineering of mobilized peripheral blood stem cells. Bone Marrow Transplant 2002; 30:69-74.
(30) Barfield RC, Otto M, Houston J, Holladay MA, Geiger T, Martin J et al. A one-step large-scale method for T- and B-cell depletion of mobilized PBSC for allogeneic transplantation. Cytotherapy 2004; 6:1-6.
(31) Handgretinger R. Negative depletion of CD3+ and TcR;+ T cells. Curr Opin Hematol 2012; 19:434-9.
(32) Huang, X.J. & Y.J. Chang. Unmanipulated HLAmismatched/haploidentical blood and marrow hematopoietic stem cell transplantation. Biol. BloodMarrow Transplant 2011; 17:197-204.
(33) Rizzieri DA, Koh LP, Long GD, Gasparetto C, Sullivan KM, Horwitz M et al. Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution. J. Clin Oncol 2007; 25:690-7.
(34) Luznik L, Bolanos-Meade J, Zahurak M, Chen AR, Smith BD, Brodsky R et al. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Blood 2010; 115:3224-30.
(35) Bader P, Soerensen J, Koehl U, Kreyenberg H, Jarisch A, Weber G et al. Excellent engraftment and rapid immune recovery in haplo-identical stem cell transplantation using CD3/CD19 depleted peripheral stem cell grafts after reduced intensity conditioning. Bone Marrow Transplant 2008; 14(2):27.
(36) Hale GA, Kasow KA, Madden R, et al. Mismatched family member donor transplantation for patients with refractory hematologic malignancies: longterm followup of a prospective clinical trial abstract. Blood (ASH Annual Meeting Abstracts) 2006; 108: abstr 3137
(37) Hale GA, Kasow KA, Gan K, et al. Haploidentical stem cell transplantation with CD3 depleted mobilized peripheral blood stem cell grafts for children with hematologic malignancies abstract. Blood (ASH Annual Meeting Abstracts) 2005; 106: abstr 2910.
(38) Tuve S, Gayoso J, Scheid C, Radke J, Kiani A, Serrano D et al. Haploidentical bone marrow transplantation with postgrafting cyclophosphamide: multicenter experience with an alternative salvage strategy. Leukemia 2011; 25:880-3.
(39) Leung W, Campana D, Yang J, Pei D, Coustan-Smith E, Gan K et al. High success rate of hematopoietic cell transplantation regardless of donor source in children with very high-risk leukemia. Blood 2011; 118(2):223-30.
(40) Ball LM, Lankester AC, Bredius RGM, Fibbe WE, van Tol MJD, Egeler RM. Graft dysfunction and delayed immune reconstitution following haploidentical peripheral blood hematopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35:S35-8.
(41) Paris C, Kopp K, King A, Santolaya ME, Zepeda AJ, Palma J. Cytomegalovirus infection in children undergoing hematopoietic stem cell transplantation in Chile. Pediatr Blood Cancer 2009; 53:453-8.
(42) Reisner Y, Martelli MF. Tolerance induction by ‘megadose’ transplants of CD34+ stem cells: a new option for leukemia patients without an HLA-matched donor. Curr Opin Immunol 2000; 12:536-41.
(43) Seggewiss, R. & H. Einsele. Immune reconstitution after allogeneic transplantation and expanding options for immunomodulation: an update. Blood 2010; 115:3861-8.
(44) Luznik L, Jalla S, Engstrom LW, Iannone R, Fuchs EJ. Durable engraftment of major histocompatibility complex-incompatible cells after nonmyeloablative conditioning with fludarabine, lowdose total body irradiation, and posttransplantation cyclophosphamide. Blood 2001; 98: 3456-64.
(45) O’Donnell PV, Luznik L, Jones RJ, Vogelsang GB, Leffell MS, Phelps M et al. Nonmyeloablative bone marrow transplantation from partially HLA-mismatched related donors using posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 2002; 8:377-86.
(46) Luznik L, O’Donnell PV, Symons HJ, Chen AR, Leffell MS, Zahurak M et al. HLA-haploidentical bone marrow transplantation for hematologicmalignancies using nonmyeloablative conditioning and high-dose posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 2008; 14:641-50.
(47) Munchel A, Kesserwan C, Symons HJ, Luznik L, Kasamon YL, Jones RJ et al. Nonmyeloablative,HLA-haploidentical bone marrow transplantation with high dose, post-transplantation cyclophosphamide. Pediatr Rep 2011; 3(Suppl 2):e15.
(48) Dominietto A, Raiola AM, Bruno B, et al. Rapid Immune Reconstitution Following Unmanipulated Haploidentical BMT with Post-Transplant High Dose Cyclophosphamide. Blood 2011(ASH Annual Meeting Abstracts); 118: Abstract 3050.
(2) Ljungman P, Bregni M, Brune M, Cornelissen J, de Witte T, Dini G et al. Allogeneic and autologous transplantation for haematological diseases, solid tumour and immune disorders: Current practice in Europe 2009. Bone Marrow Transplant 2010; 45(2) :219-34 .
(3) Gatti RA, Meuwissen HJ, Allen HD, Hong R, Good RA. Immunological reconstitution of sex-linked lymphopenic immunological deficiency. Lancet 1968; 2(7583):1366-9 .
(4) Eapen M, Rubinstein P, Zhang MJ, Camitta BM, Stevens C, Cairo MS et al. Comparable long-term survival after unrelated and HLA matched sibling donor hematopoietic stem cell transplantations for acute leukemia in children younger than 18 months. J Clin Oncol 2006; 24(1):145-51 .
(5) Dahlke J, Kroger N, Zabelina T, Ayuk F, Fehse N, Wolschke C et al. Comparable results in patients with acute lymphoblastic leukemia after related and unrelated stem cell transplantation. Bone Marrow Transplant 2006; 37(2): 155-63.
(6) Eapen M, Rubinstein P, Zhang MJ, Stevens C, Kurtzberg J, Scaradavou A et al. Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukemia: a comparison study. Lancet 2007; 369(9577):1947-54.
(7) Klingebiel T, Cornish J, Labopin M, Locatelli F, Darbyshire P, Handgretinger R et al. Results and factors influencing outcome after fully haploidentical hematopoietic stem cell transplantation in children with very high-risk acute lymphoblastic leukemia: impact of center size. An analysis on behalf of the Acute Leukemia and Pediatric Disease Working Parties of the European Blood and Marrow Transplant group. Blood 2010; 115(17):3437-46.
(8) Hough R, Cooper N, Veys P. Allogeneic haemopoietic stem cell transplantation in children: what alternative donor should we choose when no matched sibling is available? Br J Haematol 2009; 147(5):593-613.
(9) Rocha V, Locatelli F. Searching for alternative hematopoietic stem cell donors for pediatric patients. Bone Marrow Transplant 2008; 41(2):207-14.
(10) Ballen KK, Koreth J, Chen YB, Dey BR, Spitzer TR. Selection of optimal alternative graft source: mismatched unrelated donor, umbilical cord blood, or haploidentical transplant. Blood 2012; 119(9):1972-80.
(11) Zuckerman T, Rowe JM. Alternative donor transplantation in acute myeloid leukemia: which source and when? Curr Opin Hematol 2007; 14(2):152-61.
(12) Powles RL, Morgenstern GR, Kay HE, McElwain TJ, Clink HM, Dady PJ et al. Mismatched family donors for bone-marrow transplantation as treatment for acute leukemia. Lancet 1983; 1(8325):612-5.
(13) Dufort y Alvarez G, Castiglioni M, Pagés C, Dabezies A, Decaro J, Castillo L. Trasplante de progenitores hematopoyéticos en pediatría: 10 años de experiencia. Arch Pediatr Urug 2008; 79(3):201-9.
(14) Castillo LA, Fluchel M, Dabezies A, Pieri D, Brockhorst N, Barr R. Childhood cancer in Uruguay: 1992-1994. Incidence and mortality. Med Pediatr Oncol 2001; 37(4):400-4.
(15) Barker J, Krepski, TP, DeFor TE, Davies SM, Wagner JE, Weisdorf DJ. Searching for unrelated donor hematopoietic stem cells: availability and speed of umbilical cord blood versus bone marrow. Biol Blood Marrow Transplant 2002; 8(5):257-60.
(16) Grewal SS, Barker JN, Davies SM, Wagner JE. Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood? Blood 2003; 101(11):4233-44.
(17) Fondo Nacional de Recursos. Trasplante de Médula Ósea o Trasplante de Progenitores Hematopoyéticos: normativa de cobertura del Fondo Nacional de Recursos. Montevideo: FNR, 2006.Disponible en: http://www.fnr.gub.uy /sites/default/files/normativas/tecnicas/n_tmo_0.pdf Consulta: 12 dic. 2012.
(18) Stern M, Ruggeri L, Mancusi A, Bernardo ME, de Angelis C, Bucher C et al. Survival after T cell-depleted haploidentical stem cell transplantation is improved using the mother as donor. Blood 2008; 112(7):2990-5.
(19) Leuner S, Arland M, Kahl C, Jentsch-Ullrich K, Franke A, Hoffkes HG. Enumeration of CD34-positive hematopoietic progenitor cells by flow cytometry: comparison of a volumetric assay and the ISHAGE gating strategy. Bone Marrow Transplant 1998; 22(7):699-70.
(20) Dykes JH, Toporski J, Juliusson G, Békássy AN, Lenhoff S, Lindmark A et al. Rapid and effective CD3 T-cell depletion with a magnetic cell sorting program to produce peripheral blood progenitor cell products for haploidentical transplantation in children and adults. Transfusion 2007; 47:2134-42.
(21) Schumm M, Lang P, Taylor G, Kuci S, Klingebiel T, Buhring HJ et al. Isolation of highly purified autologous and allogeneic peripheral CD34+ cells using the CliniMACS device. J Hematother 1999; 8:209-18.
(22) European Society for Blood and Marrow Transplantation. Osteopetrosis: consensus guidelines for diagnosis, therapy and follow up. Disponible en: htpp: //www.ebmt.org/Contents/About-EBMT/Who-We-Are/Workingparties/Documents/00_OP_ Guidelines_02122011.pdf Consulta: 12 dic 2012
(23) Sullivan KM. Graft-versus-host-disease. In: Blume KG, Forman SJ, Appelbaum FR, editors. Thomas’ Hematopoietic Cell Transplantation. Blackwell Science Ltd., 2004:635-64
(24) Kaplan E, Meier P. Nonparametric estimation from incomplete observations. Journal of the American Statistical Association 1958; 84:360-72 .
(25) Murphy SB. The national impact of clinical cooperative group trials for pediatric cancer. Med Pediatr Oncol 1995.
(26) Handgretinger R, Chen X, Pfeiffer M, Mueller I, Feuchtinger T, Hale GA et al. Feasability and outcome of reduced intensity conditioning in haploidentical transplantation. Ann NY Acad Sci 2007; 1106:279-89.
(27) Dufort G, Pisano S, Incoronato A, Castiglioni M, Pages C, Simon E et al. Feasibility and outcome of haploidentical SCT in pediatric high-risk hematologic malignancies and Fanconi anemia in Uruguay. Bone Marrow Transplant 2012; 47(5):663-8.
(28) Handgretinger R., Klingebiel T, Lang P, Schumm M, Neu S, Geiselhart A et al. Megadose transplantation of purified peripheral blood CD34(+) progenitor cells from HLA-mismatched parental donors in children. Bone Marrow Transplant 2001; 27:777-83.
(29) Gordon PR, Leimig T, Mueller I, Babarin-Dorner A, Holladay MA, Houston J et al. A large-scale method for T cell depletion: towards graft engineering of mobilized peripheral blood stem cells. Bone Marrow Transplant 2002; 30:69-74.
(30) Barfield RC, Otto M, Houston J, Holladay MA, Geiger T, Martin J et al. A one-step large-scale method for T- and B-cell depletion of mobilized PBSC for allogeneic transplantation. Cytotherapy 2004; 6:1-6.
(31) Handgretinger R. Negative depletion of CD3+ and TcR;+ T cells. Curr Opin Hematol 2012; 19:434-9.
(32) Huang, X.J. & Y.J. Chang. Unmanipulated HLAmismatched/haploidentical blood and marrow hematopoietic stem cell transplantation. Biol. BloodMarrow Transplant 2011; 17:197-204.
(33) Rizzieri DA, Koh LP, Long GD, Gasparetto C, Sullivan KM, Horwitz M et al. Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution. J. Clin Oncol 2007; 25:690-7.
(34) Luznik L, Bolanos-Meade J, Zahurak M, Chen AR, Smith BD, Brodsky R et al. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Blood 2010; 115:3224-30.
(35) Bader P, Soerensen J, Koehl U, Kreyenberg H, Jarisch A, Weber G et al. Excellent engraftment and rapid immune recovery in haplo-identical stem cell transplantation using CD3/CD19 depleted peripheral stem cell grafts after reduced intensity conditioning. Bone Marrow Transplant 2008; 14(2):27.
(36) Hale GA, Kasow KA, Madden R, et al. Mismatched family member donor transplantation for patients with refractory hematologic malignancies: longterm followup of a prospective clinical trial abstract. Blood (ASH Annual Meeting Abstracts) 2006; 108: abstr 3137
(37) Hale GA, Kasow KA, Gan K, et al. Haploidentical stem cell transplantation with CD3 depleted mobilized peripheral blood stem cell grafts for children with hematologic malignancies abstract. Blood (ASH Annual Meeting Abstracts) 2005; 106: abstr 2910.
(38) Tuve S, Gayoso J, Scheid C, Radke J, Kiani A, Serrano D et al. Haploidentical bone marrow transplantation with postgrafting cyclophosphamide: multicenter experience with an alternative salvage strategy. Leukemia 2011; 25:880-3.
(39) Leung W, Campana D, Yang J, Pei D, Coustan-Smith E, Gan K et al. High success rate of hematopoietic cell transplantation regardless of donor source in children with very high-risk leukemia. Blood 2011; 118(2):223-30.
(40) Ball LM, Lankester AC, Bredius RGM, Fibbe WE, van Tol MJD, Egeler RM. Graft dysfunction and delayed immune reconstitution following haploidentical peripheral blood hematopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35:S35-8.
(41) Paris C, Kopp K, King A, Santolaya ME, Zepeda AJ, Palma J. Cytomegalovirus infection in children undergoing hematopoietic stem cell transplantation in Chile. Pediatr Blood Cancer 2009; 53:453-8.
(42) Reisner Y, Martelli MF. Tolerance induction by ‘megadose’ transplants of CD34+ stem cells: a new option for leukemia patients without an HLA-matched donor. Curr Opin Immunol 2000; 12:536-41.
(43) Seggewiss, R. & H. Einsele. Immune reconstitution after allogeneic transplantation and expanding options for immunomodulation: an update. Blood 2010; 115:3861-8.
(44) Luznik L, Jalla S, Engstrom LW, Iannone R, Fuchs EJ. Durable engraftment of major histocompatibility complex-incompatible cells after nonmyeloablative conditioning with fludarabine, lowdose total body irradiation, and posttransplantation cyclophosphamide. Blood 2001; 98: 3456-64.
(45) O’Donnell PV, Luznik L, Jones RJ, Vogelsang GB, Leffell MS, Phelps M et al. Nonmyeloablative bone marrow transplantation from partially HLA-mismatched related donors using posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 2002; 8:377-86.
(46) Luznik L, O’Donnell PV, Symons HJ, Chen AR, Leffell MS, Zahurak M et al. HLA-haploidentical bone marrow transplantation for hematologicmalignancies using nonmyeloablative conditioning and high-dose posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 2008; 14:641-50.
(47) Munchel A, Kesserwan C, Symons HJ, Luznik L, Kasamon YL, Jones RJ et al. Nonmyeloablative,HLA-haploidentical bone marrow transplantation with high dose, post-transplantation cyclophosphamide. Pediatr Rep 2011; 3(Suppl 2):e15.
(48) Dominietto A, Raiola AM, Bruno B, et al. Rapid Immune Reconstitution Following Unmanipulated Haploidentical BMT with Post-Transplant High Dose Cyclophosphamide. Blood 2011(ASH Annual Meeting Abstracts); 118: Abstract 3050.
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2014-03-31
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Dufort G, Castillo LA, Pisano S, Castiglioni M, Pagés C, Simón E, et al. Haploidentical allogeneic hematopoietic transplant of hematopoietic parents in pediatrics in Uruguay. Rev. Méd. Urug. [Internet]. 2014 Mar. 31 [cited 2024 Nov. 23];30(1):17-29. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/256
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