Allogeneic hematopoietic cell transplantation for XIAP deficiency: an international survey reveals poor outcomes

Blood. 2013 Feb 7;121(6):877-83. doi: 10.1182/blood-2012-06-432500. Epub 2012 Nov 6.

Abstract

There have been no studies on patient outcome after allogeneic hematopoietic cell transplantation (HCT) in patients with X-linked inhibitor of apoptosis (XIAP) deficiency. To estimate the success of HCT, we conducted an international survey of transplantation outcomes. Data were reported for 19 patients. Seven patients received busulfan-containing myeloablative conditioning (MAC) regimens. Eleven patients underwent reduced intensity conditioning (RIC) regimens predominantly consisting of alemtuzumab, fludarabine, and melphalan. One patient received an intermediate-intensity regimen. Survival was poor in the MAC group, with only 1 patient surviving (14%). Most deaths were from transplantation-related toxicities, including venoocclusive disease and pulmonary hemorrhage. Of the 11 patients who received RIC, 6 are currently surviving at a median of 570 days after HCT (55%). Preparative regimen and HLH activity affected outcomes, and of RIC patients reported to be in remission from HLH, survival is 86% (P = .03). We conclude that MAC regimens should not be used for patients with XIAP deficiency. It is possible that the loss of XIAP and its antiapoptotic functions contributes to the high incidence of toxicities observed with MAC regimens. RIC regimens should be pursued with caution and, if possible, efforts should be made to ensure HLH remission before HCT in these patients.

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Europe
  • Genetic Diseases, X-Linked / genetics
  • Genetic Diseases, X-Linked / mortality
  • Genetic Diseases, X-Linked / therapy*
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods*
  • Hemorrhage / etiology
  • Hepatic Veno-Occlusive Disease / etiology
  • Humans
  • Infant
  • Japan
  • Lung / blood supply
  • Lymphoproliferative Disorders / genetics
  • Lymphoproliferative Disorders / mortality
  • Lymphoproliferative Disorders / therapy*
  • Mutation
  • Outcome Assessment, Health Care / statistics & numerical data
  • Remission Induction
  • Retrospective Studies
  • Survival Analysis
  • Survival Rate
  • Transplantation Conditioning / methods*
  • Transplantation, Homologous
  • United States
  • X-Linked Inhibitor of Apoptosis Protein / genetics
  • Young Adult

Substances

  • X-Linked Inhibitor of Apoptosis Protein
  • XIAP protein, human

Supplementary concepts

  • Lymphoproliferative Syndrome, X-Linked, 2