Faculty Collaboration Database

GRFS and CRFS in alternative donor hematopoietic cell transplantation for pediatric patients with acute leukemia. Blood Adv 2019 May 14;3(9):1441-1449

Date

05/06/2019

Pubmed ID

31053571

Pubmed Central ID

PMC6517657

DOI

10.1182/bloodadvances.2018030171

Scopus ID

2-s2.0-85068626630 (requires institutional sign-in at Scopus site)   11 Citations

Abstract

We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors.

Author List

Mehta RS, Holtan SG, Wang T, Hemmer MT, Spellman SR, Arora M, Couriel DR, Alousi AM, Pidala J, Abdel-Azim H, Ahmed I, Aljurf M, Askar M, Auletta JJ, Bhatt V, Bredeson C, Chhabra S, Gadalla S, Gajewski J, Gale RP, Gergis U, Hematti P, Hildebrandt GC, Inamoto Y, Kitko C, Khandelwal P, MacMillan ML, Majhail N, Marks DI, Mehta P, Nishihori T, Olsson RF, Pawarode A, Diaz MA, Prestidge T, Qayed M, Rangarajan H, Ringden O, Saad A, Savani BN, Seo S, Shah A, Shah N, Schultz KR, Solh M, Spitzer T, Szer J, Teshima T, Verdonck LF, Williams KM, Wirk B, Wagner J, Yared JA, Weisdorf DJ

Authors

Peiman Hematti MD Professor in the Medicine department at Medical College of Wisconsin
Tao Wang PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

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

Adolescent
Alemtuzumab
Bone Marrow Cells
Child
Child, Preschool
Disease-Free Survival
Female
Fetal Blood
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Proportional Hazards Models
Recurrence
Survival Rate
Thyroglobulin
Transplantation Conditioning
Whole-Body Irradiation