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Allogeneic hematopoietic stem cell transplantation for inherited disorders: experience in a single center.
[adrenomyeloneuropathy]
Allogeneic
hematopoietic
stem
cell
transplantation
(
ASCT
)
is
a
possible
cure
for
many
inherited
disorders
.
We
report
20
years
of
experience
in
71
patients
.
The
disorders
include
7
immunodeficiencies
,
21
hematological
disorders
,
13
histiocytic
disorders
,
9
mucopolysaccharoidoses
,
7
metachromatic
leukodystrophies
(
MLD
)
,
3
adrenoleukodystrophies
(
ALD
)
,
2
adrenomyeloneuropathy
(
AMN
)
,
6
patients
with
Gaucher
's
disease
,
1
Sandhoff
's
disease
,
and
2
patients
with
aspartylglucosaminuria
.
Their
median
age
was
4
(
0
-
39
)
years
.
The
donors
were
29
HLA-identical
related
,
27
matched
unrelated
(
MUD
)
and
15
HLA
mismatches
.
In
recipients
of
HLA-identical
sibling
grafts
,
none
developed
acute
GVHD
grades
II
-IV
as
against
22
%
in
all
others
.
The
overall
cumulative
incidence
of
chronic
GVHD
was
17
%
.
The
5
-
year
survival
rates
were
93
%
,
84
%
,
and
46
%
in
recipients
of
grafts
from
HLA-identical
siblings
,
MUD
and
HLA-mismatches
,
respectively
.
The
overall
10
-
year
survival
rate
was
69
%
.
All
of
the
surviving
patients
with
immunodeficiencies
and
hemoglobinopathies
are
well
.
Four
patients
with
Hurler
's
disease
are
also
well
,
apart
from
skeletal
problems
.
Five
patients
with
Gaucher
's
disease
are
between
14
and
22
years
after
the
transplant
.
Two
infants
with
MLD
deteriorated
,
a
girl
with
the
juvenile
form
has
stable
disease
and
one
woman
with
the
adult
form
has
improved
.
Among
four
survivors
with
ALD
/
AMN
,
three
are
well
and
one
has
dementia
.
Two
patients
with
aspartylglucosaminuria
have
stable
disease
.
In
patients
with
inborn
errors
of
metabolism
,
ASCT
gives
a
high
survival
rate
using
HLA-matched
donors
.
Beneficial
effects
are
seen
in
those
who
are
transplanted
early
.
Diseases
Validation
Diseases presenting
"dementia"
symptom
adrenomyeloneuropathy
alexander disease
cadasil
canavan disease
carcinoma of the gallbladder
cushing syndrome
gm1 gangliosidosis
hereditary cerebral hemorrhage with amyloidosis
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
phenylketonuria
sneddon syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated