Conclusion de l’atelier

1) Notre travail se limite aux indications classiques excluant les greffes pour hémoglobinopathies et autres pathologies constitutionnelles.
2) Nous encourageons les centres à privilégier les essais cliniques.
3) Il est possible de limiter le nombre de conditionnements :
        a) MAC : 3 conditionnements (exemples : Cy-ICT (8-12 Gys); Cy-BU et Flu-BU4)
        b) Séquentiel: 1 conditionnement (exemple: KOLB)
        c) Atténué : (RIC) un conditionnement (Slavin=Flu-BU2-SAL2); (NMA) un conditionnement (exemple : Seattle= ICT2+/-Flu)
        d) AM: deux conditionnements (exemples, géno : Cy-SAL; phéno : Cy-Flu-ICT2-SAL.
        e) Cordon: deux conditionnements (exemples, MAC: Fluda-ICT12-Cy; RIC: Fluda-ICT2-Cy)
4) Pour les greffes à conditionnement atténué où la source de cellules est la moelle, le risque de rejet justifie la modification du conditionnement.
5) Si greffes non apparenté et CSP (9-10/10) ou Mo (9/10), le conditionnement doit comporter du SAL.

Recommandations

En tenant compte des données ci-dessus, chaque centre devrait pouvoir choisir une ou deux types de conditionnement par intensité. Le tableau 1 peut être rempli avec les choix du centre en fonction des modalités de la greffe à proposer et l’indication. Le tableau 2 représente un exemple pour un centre donné.   

Questions résiduelles à explorer

1) Place réelle de l’ICT dans le conditionnement myéloablatif des LAL.
2) RIC/MAC et LAM RC1 ?
3) Faut-il rajouter du SAL si greffon médullaire (MO) à partir d’un donneur non apparenté 10/10?
4) Quel RIC si greffon MO pour éviter le risque de rejet?

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