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
Date
03/13/2012Pubmed ID
22406037Pubmed Central ID
PMC3890239DOI
10.1016/j.bbmt.2012.01.007Scopus ID
2-s2.0-84864005064 (requires institutional sign-in at Scopus site) 50 CitationsAbstract
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 ELAuthors
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of WisconsinBrent R. Logan PhD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Elizabeth Thiel MD Associate 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
MESH terms used to index this publication - Major topics in bold
AdolescentBone 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