title: Outcomes of pediatric bone marrow transplantation for leukemia and myelodysplasia using matched sibling, mismatched related, or matched unrelated donors.
abstract: Although some trials have allowed matched or single human leukocyte antigen (HLA)-mismatched related donors (mmRDs) along with HLA-matched sibling donors (MSDs) for pediatric bone marrow transplantation in early-stage hematologic malignancies, whether mmRD grafts lead to similar outcomes is not known. We compared patients < 18 years old reported to the Center for International Blood and Marrow Transplant Research with acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and myelodysplastic syndrome undergoing allogeneic T-replete, myeloablative bone marrow transplantation between 1993 and 2006. In total, patients receiving bone marrow from 1208 MSDs, 266 8/8 allelic-matched unrelated donors (URDs), and 151 0-1 HLA-antigen mmRDs were studied. Multivariate analysis showed that recipients of MSD transplants had less transplantation-related mortality, acute graft-versus-host disease (GVHD), and chronic GVHD, along with better disease-free and overall survival than the URD and mmRD groups. No differences were observed in transplant-related mortality, acute and chronic GVHD, relapse, disease-free survival, or overall survival between the mmRD and URD groups. These data show that mmRD and 8/8 URD outcomes are similar, whereas MSD outcomes are superior to the other 2 sources. Whether allele level typing could identify mmRD recipients with better outcomes will not be known unless centers alter practice and type mmRD at the allele level.
authors.affiliation: Children's Hospital at Westmead, Sydney, Australia. Peters@chw.edu.au
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Shaw
authors.forename: Fangyu
authors.initials: F
authors.lastname: Kan
authors.forename: Kwang
authors.initials: K
authors.lastname: Woo Ahn
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Spellman
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.forename: Mouhab
authors.initials: M
authors.lastname: Ayas
authors.forename: Michael
authors.initials: M
authors.lastname: Burke
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Allen R
authors.initials: AR
authors.lastname: Chen
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
authors.forename: James
authors.initials: J
authors.lastname: Gajewski
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Kamar
authors.initials: K
authors.lastname: Godder
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Martin B A
authors.initials: MB
authors.lastname: Heemskerk
authors.forename: John
authors.initials: J
authors.lastname: Horan
authors.forename: Naynesh
authors.initials: N
authors.lastname: Kamani
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kasow
authors.forename: Ka Wah
authors.initials: KW
authors.lastname: Chan
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Wing H
authors.initials: WH
authors.lastname: Leung
authors.forename: Victor A
authors.initials: VA
authors.lastname: Lewis
authors.forename: David
authors.initials: D
authors.lastname: Miklos
authors.forename: Machteld
authors.initials: M
authors.lastname: Oudshoorn
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Jean
authors.initials: J
authors.lastname: Sanders
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Schultz
authors.forename: Adriana
authors.initials: A
authors.lastname: Seber
authors.forename: Michelle
authors.initials: M
authors.lastname: Setterholm
authors.forename: Donna A
authors.initials: DA
authors.lastname: Wall
authors.forename: Lolie
authors.initials: L
authors.lastname: Yu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006680:HLA Antigens; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D035781:Siblings; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens