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Comparative Study
. 2012 Aug;18(8):1204-10.
doi: 10.1016/j.bbmt.2012.01.007. Epub 2012 Mar 6.

Comparison of outcomes after HLA-matched sibling and unrelated donor transplantation for children with high-risk acute lymphoblastic leukemia

Mei-Jie Zhang  1 , Stella M Davies, Bruce M Camitta, Brent Logan, Karin Tiedemann, Mary Eapen, Elizabeth L Thiel
Affiliations
Comparative Study

Comparison of outcomes after HLA-matched sibling and unrelated donor transplantation for children with high-risk acute lymphoblastic leukemia

Mei-Jie Zhang et al. Biol Blood Marrow Transplant. 2012 Aug.

Erratum in

  • Biol Blood Marrow Transplant. 2012 Sep;18(9):1466. Thiel, Elizabeth L [added]

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.

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Figures

Figure 1
Figure 1
Figure 1A: Probabilities of non-relapse mortality by haematopoietic stem-cell source and donor-recipient HLA matching: A = HLA-matched sibling BM, B = matched unrelated BM, C = mismatched unrelated BM and D = cord blood transplants Figure 1B: Probabilities of relapse by haematopoietic stem-cell source and donor-recipient HLA matching: A = HLA-matched sibling BM, B = matched unrelated BM, C = mismatched unrelated BM and D = cord blood transplants
Figure 1
Figure 1
Figure 1A: Probabilities of non-relapse mortality by haematopoietic stem-cell source and donor-recipient HLA matching: A = HLA-matched sibling BM, B = matched unrelated BM, C = mismatched unrelated BM and D = cord blood transplants Figure 1B: Probabilities of relapse by haematopoietic stem-cell source and donor-recipient HLA matching: A = HLA-matched sibling BM, B = matched unrelated BM, C = mismatched unrelated BM and D = cord blood transplants
Figure 2
Figure 2
Probabilities of leukemia-free survival by haematopoietic stem-cell source and donor-recipient HLA matching: A = HLA-matched sibling BM, B = matched unrelated BM, C = mismatched unrelated BM and D = cord blood transplants
See this image and copyright information in PMC

References

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