Hematopoietic Stem Cell Transplantation Activity in Pediatric Cancer between 2008 and 2014 in the United States: A Center for International Blood and Marrow Transplant Research Report

Abstract

This Center for International Blood and Marrow Transplant Research report describes the use of hematopoietic stem cell transplantation (HSCT) in pediatric patients with cancer, 4408 undergoing allogeneic (allo) and3076 undergoing autologous (auto) HSCT in the United States between 2008 and 2014. In both settings, there was a greater proportion of boys (n = 4327; 57%), children < 10 years of age (n = 4412; 59%), whites (n = 5787; 77%), and children with a performance score ≥ 90% at HSCT (n = 6187; 83%). Leukemia was the most common indication for an allo-transplant (n = 4170; 94%), and among these, acute lymphoblastic leukemia in second complete remission (n = 829; 20%) and acute myeloid leukemia in first complete remission (n = 800; 19%) werethe most common. The most frequently used donor relation, stem cell sources, and HLA match were unrelated donor (n = 2933; 67%), bone marrow (n = 2378; 54%), and matched at 8/8 HLA antigens (n = 1098; 37%) respectively. Most allo-transplants used myeloablative conditioning (n = 4070; 92%) and calcineurin inhibitors and methotrexate (n = 2245; 51%) for acute graft-versus-host disease prophylaxis. Neuroblastoma was the most common primary neoplasm for an auto-transplant (n = 1338; 44%). Tandem auto-transplants for neuroblastoma declined after 2012 (40% in 2011, 25% in 2012, and 8% in 2014), whereas tandem auto-transplants increased for brain tumors (57% in 2008 and 77% in 2014). Allo-transplants from relatives other than HLA-identical siblings doubled between 2008 and 2014 (3% in 2008 and 6% in 2014). These trends will be monitored in future reports of transplant practices in the United States.

Keywords: Hematopoietic stem cell transplantation; Pediatric cancers.

Figure 1

1A. Conditioning intensity for all allogeneic transplants between 2008 and 2014. The percentage of allogeneic transplant patients who received either myeloablative or a reduced intensity or non/myeloablative conditioning regimen are shown. 1B. Donor relation in allogeneic HSCT between 2008 and 2014. The percentage of all allogeneic transplants that received either an HLA-identical sibling donors, other relative donors or unrelated donors are shown. 1C. Stem cell sources in allogeneic HSCT between 2008 and 2014. The percentage of all allogeneic transplants that received either a bone marrow, peripheral blood stem cell or umbilical cord blood are shown. 1D. Allogeneic transplant for various leukemia subtypes between 2008 and 2014. The percentage of all leukemia patients that received an allogeneic transplant that were acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), myelodysplastic syndrome/myeloproliferative neoplasms or other myeloid disorders (MDS/MPN), bi-phenotypic leukemia (BL) or other leukemia (OL) are shown. 1E. Disease status prior to an allogeneic transplant in acute lymphoid leukemia (ALL) is shown. Percentage of ALL patients transplanted in first complete remission (CR1), second complete remission (CR2), third complete remission (CR3), primary induction failure (PIF), first relapse and second or greater relapse is shown. 1F. Disease status prior to an allogeneic transplant in acute myeloid leukemia (AML) is shown. Percentage of AML patients transplanted in first complete remission (CR1), second complete remission (CR2), third complete remission (CR3), primary induction failure (PIF), first relapse and second or greater relapse is shown 1G. Percentage of patients with lymphoma who received an allogeneic transplant between 2008 and 2014. 1H. Percentage of patients with lymphoma who received an autologous transplant between 2008 and 2014.

Figure 2

2A. Percentage of patients with various solid tumors who underwent an autologous transplant between 2008 and 2014. Percentage of all autologous transplant patients with an underlying diagnosis of a neuroblastoma, medulloblastoma, other central nervous system (CNS) tumors, Ewing family tumors, retinoblastoma, germ cell tumors, Wilms tumor, gonadal tumors, rhabdomyosarcoma and other solid tumors. 2B. Percentage of patients with various solid tumors who received tandem autologous HSCTs between 2008 and 2014. Percentage of all tandem autologous transplant patients with an underlying diagnosis of medulloblastoma, other central nervous system (CNS) tumors, neuroblastoma, Ewing family tumors, retinoblastoma, germ cell tumors and gonadal tumors.