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Comparison of outcomes after HLA-matched sibling and unrelated donor transplantation for children with high-risk acute lymphoblastic leukemia. Biol Blood Marrow Transplant 2012 Aug;18(8):1204-10 PMID: 22406037 PMCID: PMC3890239

Pubmed ID

22406037

DOI

10.1016/j.bbmt.2012.01.007

Abstract

We compared outcomes after 94 HLA-matched sibling, 168 unrelated donor bone marrow (BM; n = 81 matched and n = 88 mismatched), and 86 cord blood transplantations in patients age 1 to 15 years with acute lymphoblastic leukemia (ALL) in second complete remission (CR). All patients had their first BM relapse within 3 years from diagnosis. Cox regression models were constructed to examine for differences in transplant outcome by donor source. Risks of grade 2 to 4 acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD), when compared to HLA-matched sibling transplants, were higher after matched unrelated donor BM (relative risk [RR], 2.42; P = .001; RR, 5.12; P < .001, respectively), mismatched BM (RR, 3.24; P < .001; RR, 5.19; P < .001, respectively), and cord blood (RR, 2.67; P < .001; RR, 2.54; P = .024, respectively) transplants. Although nonrelapse mortality was higher after transplantation of mismatched unrelated donor BM and cord blood, there were no differences in leukemia-free survival (LFS) between HLA-matched sibling and any of the unrelated donor transplantations. The 3-year probabilities of LFS were 50% after HLA-matched sibling and 44% after matched unrelated BM, and 44% after mismatched unrelated BM and 43% after cord blood transplantation. Our observations support transplantation of BM or cord blood from a suitably matched unrelated donor or cord blood for patients without an HLA-matched sibling with ALL in second CR.

Author List

Zhang MJ, Davies SM, Camitta BM, Logan B, Tiedemann K, Eapen M, Thiel EL

Authors

Bruce M. Camitta MD Clinical Professor in the Medicine department at Medical College of Wisconsin
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin
Brent R. Logan PhD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Elizabeth Thiel MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-84864005064   31 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Bone Marrow Transplantation
Child
Child, Preschool
Cord Blood Stem Cell Transplantation
Disease-Free Survival
HLA-A Antigens
Histocompatibility Testing
Humans
Infant
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Risk Factors
Siblings
Survival Analysis
Tissue Donors
Treatment Outcome
Unrelated Donors
jenkins-FCD Prod-332 f92a19b0ec5e8e1eff783fac390ec127e367c2b5