Применение малых доз децитабина с целью профилактики рецидива гемобластозов после аллогенной трансплантации гемопоэтических стволовых клеток: опыт одного центра

Abstract

Relapse, graft-versus-host disease (GvHD) and GvHD-associated mortality are major obstacles to success of transplantation from allogenic donors in children with hematologic malignancies. Negative depletion of αβ (+) T-cells and CD19+ B lymphocytes, which permits to maintain mature donor-derived natural killer cells and γδ(+) T cells in the graft may improve GvHD control, but decrease GVL (graft versus leukemia) effect. Additional attempts at relapse prevention may be posttransplant use of hypomethylating agents. In this article, we report the results of a pilot study of decitabine safety in children with hematologic malignancies after allogeneic HSCT in our center. A total of 63 pediatric patients with hematologic malignancies underwent allogeneic HSCT between May 2012 and November 2013 enrolled in this study. Group «Decitabine+» consisted of 33 patients (14 – AML, 12 – ALL, 6 – UMML), group «Decitabine-» 31 patients (12 – AML, 17 – ALL, 2 – UMML). Decitabine was used in low dose 10 mg/m2/day during 5 days. 32 patients recieved 133 courses with median number of courses 4 (2–6). Hematologic toxicity included grade IV neutropenia in 35%, grade III in 33%, grade II in 19%; grade IV thrombocytopenia in 7,6%, grade III in 7%, infections complicated in 33%. In group «Decitabine+» 11 of the 32 patients experienced disease relapse, (mean of time to relapse 1 year), in group «Decitabine-» 9 patients (mean of time 0,42 y), p = 0,13. Decitabine can be administered to children on outpatient basis post-transplant with mostly moderate hematologic and mild visceral toxicity. Efficacy of post-transplant decitabine can be safely evaluated in a prospective controlled trial.