title: Comparable long-term survival after unrelated and HLA-matched sibling donor hematopoietic stem cell transplantations for acute leukemia in children younger than 18 months.
abstract: OBJECTIVE
  To describe outcomes after unrelated donor stem cell transplantation (HCT) in children (< 18 months at diagnosis) with acute leukemia and compare these with outcomes after human leukocyte antigen (HLA)-matched sibling donor HCT.
  
  
  METHODS
  We compared the results of unrelated donor HCT with bone marrow (n = 85) or cord blood grafts (n = 81) and HLA-matched sibling donor HCT with bone marrow grafts (n = 101) for acute myeloid or acute lymphoblastic leukemia using Cox proportional hazards models. Unrelated donor HCT recipients were younger, more likely to have MLL gene rearrangement, to have advanced leukemia, and to receive irradiation before HCT.
  
  
  RESULTS
  Treatment-related mortality rates were 6%, 15%, and 31% after matched sibling, unrelated donor bone marrow, and cord blood HCT, respectively. Risks of relapse, overall and leukemia-free survival were significantly associated with disease status at transplantation. Though leukemia recurrence was lowest after unrelated donor HCT in first clinical remission (CR), overall survival, and leukemia-free survival rates were similar after matched sibling and unrelated donor HCT, after adjustment for disease status. Relapse, overall and leukemia-free survival did not differ by graft type (bone marrow v cord blood) or type of leukemia. Three-year probabilities of leukemia-free survival were 49% and 54% after HLA-matched sibling and unrelated donor transplantation in first CR, respectively. Corresponding rates for those with advanced leukemia were 20% and 30%.
  
  
  CONCLUSIONS
  Unrelated donor HCT should be considered for infants with acute leukemia in first CR using the same eligibility criteria as are currently used for those with HLA matched sibling donors.
authors.affiliation: Center for Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA. meapen@mail.mcw.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Pablo
authors.initials: P
authors.lastname: Rubinstein
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Camitta
authors.forename: Cladd
authors.initials: C
authors.lastname: Stevens
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: John J
authors.initials: JJ
authors.lastname: Doyle
authors.forename: Joanne
authors.initials: J
authors.lastname: Kurtzberg
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Ortega
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
mesh_terms: D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D009504:Neutrophils / Q000502:physiology; D010976:Platelet Count; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D035781:Siblings; D017741:Survivors