title: Partially mismatched related-donor bone marrow transplantation for pediatric patients with acute leukemia: younger donors and absence of peripheral blasts improve outcome.
abstract: OBJECTIVE
  To extend access to bone marrow transplantation (BMT), we used partially mismatched related donors (PMRD) for pediatric patients with acute leukemia. In this report we sought to determine pretransplantation factors that might predict outcome.
  
  
  METHODS
  Of 67 such patients, 43 had acute lymphocytic leukemia and 24 had acute myelogenous leukemia. At the time of transplantation, 41 patients were in relapse. Donors included 40 parents, 24 siblings, and three cousins. HLA disparity of two to three major antigens was detected in two thirds of the donor-recipient pairs. Conditioning therapy, including total-body irradiation and chemotherapy followed by graft-versus-host disease (GvHD) prophylaxis with partial T-cell depletion of the graft using T10B9 or OKT3, was combined with posttransplantation immunosuppression.
  
  
  RESULTS
  Estimated probability (EP) of engraftment was 0.96 and was not affected by donor-antigen mismatch (AgMM; P =.732). EP of grades 2 to 4 acute GvHD was 0.24 and was not affected by recipient AgMM (P =.796). EP of disease-free survival was 0.26 at 3 years but improved to 0.45 when donors were younger than 30 years (P<.001). EP of relapse at 3 years was 0.41 and reduced with younger donors' age. For patients who were in relapse at the time of transplantation, absence of blasts was associated with a lower relapse rate (0.46 v. 0.84; P =. 083), similar to that of patients in remission.
  
  
  CONCLUSIONS
  PMRD-BMT in pediatric leukemia resulted in high engraftment and low GvHD rates. To improve outcomes, younger donors should be sought, and clinicians should attempt to reduce peripheral blasts in patients who are in relapse.
authors.affiliation: Division of Transplantation Medicine, Palmetto Richland Memorial Hospital, University of South Carolina, Columbia, SC 29203, USA. kamar.godder@rmh.edu
authors.forename: K T
authors.initials: KT
authors.lastname: Godder
authors.forename: L J
authors.initials: LJ
authors.lastname: Hazlett
authors.forename: S H
authors.initials: SH
authors.lastname: Abhyankar
authors.forename: K Y
authors.initials: KY
authors.lastname: Chiang
authors.forename: N P
authors.initials: NP
authors.lastname: Christiansen
authors.forename: K D
authors.initials: KD
authors.lastname: Bridges
authors.forename: C G
authors.initials: CG
authors.lastname: Lee
authors.forename: S S
authors.initials: SS
authors.lastname: Geier
authors.forename: K S
authors.initials: KS
authors.lastname: Goon-Johnson
authors.forename: A P
authors.initials: AP
authors.lastname: Gee
authors.forename: A R
authors.initials: AR
authors.lastname: Pati
authors.forename: R S
authors.initials: RS
authors.lastname: Parrish
authors.forename: P J
authors.initials: PJ
authors.lastname: Henslee-Downey
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014019:Tissue Donors / Q000145:classification; D014184:Transplantation, Homologous