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Multicenter Study
. 2019 Apr 9;3(7):1118-1128.
doi: 10.1182/bloodadvances.2018025908.

The influence of stem cell source on transplant outcomes for pediatric patients with acute myeloid leukemia

Amy K Keating  1 , Jurgen Langenhorst  2 , John E Wagner  3 , Kristin M Page  4 , Paul Veys  5 , Robert F Wynn  6 , Heather Stefanski  3 , Reem Elfeky  5 , Roger Giller  1 , Richard Mitchell  7   8 , Filippo Milano  9 , Tracey A O'Brien  7   8 , Ann Dahlberg  9 , Colleen Delaney  9 , Joanne Kurtzberg  4 , Michael R Verneris  1 , Jaap Jan Boelens  2   10   11
Affiliations
Multicenter Study

The influence of stem cell source on transplant outcomes for pediatric patients with acute myeloid leukemia

Amy K Keating et al. Blood Adv. .

Erratum in

Abstract

When hematopoietic stem cell transplant (HSCT) is necessary for children with acute myeloid leukemia (AML), there remains debate about the best stem cell source. Post-HSCT relapse is a common cause of mortality, and complications such as chronic graft versus host disease (cGVHD) are debilitating and life-threatening. To compare post-HSCT outcomes of different donor sources, we retrospectively analyzed consecutive transplants performed in several international centers from 2005 to 2015. A total of 317 patients were studied: 19% matched sibling donor (MSD), 23% matched unrelated donor (MUD), 39% umbilical cord blood (UCB), and 19% double UCB (dUCB) recipients. The median age at transplant was 10 years (range, 0.42-21 years), and median follow-up was 4.74 years (range, 4.02-5.39 years). Comparisons were made while controlling for patient, transplant, and disease characteristics. There were no differences in relapse, leukemia-free survival, or nonrelapse mortality. dUCB recipients had inferior survival compared with matched sibling recipients, but all other comparisons showed similar overall survival. Despite the majority of UCB transplants being HLA mismatched, the rates of cGVHD were low, especially compared with the well-matched MUD recipients (hazard ratio, 0.3; 95% confidence interval, 0.14-0.67; P = .02). The composite measure of cGVHD and leukemia-free survival (cGVHD-LFS), which represents both the quality of life and risk for mortality, was significantly better in the UCB compared with the MUD recipients (HR, 0.56; 95% confidence interval, 0.34-1; P = .03). In summary, the use of UCB is an excellent donor choice for pediatric patients with AML when a matched sibling cannot be identified.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Hematopoietic engraftment. Probability and timeline of neutrophil (A) and platelet (B) recovery by stem cell source.
Figure 2.
Figure 2.
Kaplan-Meier estimates of posttransplant relapse. Incidence of relapse by stem cell source overall.
Figure 3.
Figure 3.
Kaplan-Meier estimates of posttransplant outcomes by stem cell source. LFS (A), nonrelapse mortality (B), and OS (C) compared by stem cell source.
Figure 4.
Figure 4.
Incidence of GVHD. The incidence of grades II to IV aGVHD (A), incidence of grades III to IV aGVHD (B), and cGVHD (C) compared by stem cell source.
Figure 5.
Figure 5.
Composite endpoint cGVHD-LFS. The composite endpoint of cGVHD-LFS.
See this image and copyright information in PMC

References

    1. Khandelwal P, Millard HR, Thiel E, et al. . 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. Biol Blood Marrow Transplant. 2017;23(8):1342-1349. - PMC - PubMed
    1. Martin PJ, Inamoto Y, Carpenter PA, Lee SJ, Flowers ME. Treatment of chronic graft-versus-host disease: past, present and future. Korean J Hematol. 2011;46(3):153-163. - PMC - PubMed
    1. Vrooman LM, Millard HR, Brazauskas R, et al. . Survival and late effects after allogeneic hematopoietic cell transplantation for hematologic malignancy at less than three years of age. Biol Blood Marrow Transplant. 2017;23(8):1327-1334. - PMC - PubMed
    1. Boyiadzis M, Arora M, Klein JP, et al. . Impact of chronic graft-versus-host disease on late relapse and survival on 7,489 patients after myeloablative allogeneic hematopoietic cell transplantation for leukemia. Clin Cancer Res. 2015;21(9):2020-2028. - PMC - PubMed
    1. Jacobsohn DA, Arora M, Klein JP, et al. . Risk factors associated with increased nonrelapse mortality and with poor overall survival in children with chronic graft-versus-host disease. Blood. 2011;118(16):4472-4479. - PMC - PubMed

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