Long-term outcome of allogeneic PBSC transplantation in pediatric patients with hematological malignancies: a report of the Spanish Working Party for Blood and Marrow Transplantation in Children (GETMON) and the Spanish Group for Allogeneic Peripheral Blood Transplantation (GETH).
We analyzed the clinical outcome in 90 children undergoing allogeneic PBSC transplantation from HLA-identical relative for leukemia. GvHD prophylaxis was CsA+ methotrexate in 50 and CsA+/-steroids in 40. Median CD34+ cells infused were 6 x 10(6)/kg (range, 1.4-32). Median follow-up was 60 months (range, 6-115). CI of transplant-related mortality (TRM) was 18.4+/-4%. On multivariate analysis, high Lansky score (>80) at transplantation was associated with lower TRM (HR, 0.9; P<0.0002). Relapse incidence (RI) was 33.6+/-6%. On multivariate analysis, high Lansky score at transplantation and cGvHD were associated with lower RI (HR, 0.04; P<0.0005 and HR, 0.23; P<0.03, respectively). Disease-free survival (DFS) was 57.8+/-5%. Disease status at transplantation (HR, 0.33; P<0.02), steroid treatment at day +90 (HR, 5.61; P<0.005) and cGvHD (HR, 0.23; P<0.005) had a significant impact on DFS in multivariate analysis. CI of cGvHD was 63.7+/-7%. Patients with cGvHD had better DFS (65+/-5%) because of lower RI (15.7+/-6%) and similar TRM (27.4+/-4%). These data suggest acceptable long-term outcomes after allogeneic PBSC transplantation in children despite the high incidence of cGvHD. These patients had a lower risk of relapse and a better DFS.
Diaz
M A
MA
Department of Pediatrics, Division of Pediatric Hematology Oncology, Hospital Infantil Niño Jesus, Madrid, Spain. mdiaz.hnjs@salud.madrid.org
Gonzalez-Vicent
M
M
Gonzalez
M E
ME
Verdeguer
A
A
Martinez
A
A
Perez-Hurtado
M
M
Badell
I
I
de la Rubia
J
J
Bargay
J
J
de Arriba
F
F
Diez
J L
JL
Caballero
D
D
Madero
L
L
Brunet
S
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D006405:Hematology; D006801:Humans; D015994:Incidence; D007223:Infant; D007938:Leukemia / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D010372:Pediatrics; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D014184:Transplantation, Homologous