Outcomes of pediatric bone marrow transplantation for leukemia and myelodysplasia using matched sibling, mismatched related, or matched unrelated donors.
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.
Shaw
Peter J
PJ
Children's Hospital at Westmead, Sydney, Australia. Peters@chw.edu.au
Kan
Fangyu
F
Woo Ahn
Kwang
K
Spellman
Stephen R
SR
Aljurf
Mahmoud
M
Ayas
Mouhab
M
Burke
Michael
M
Cairo
Mitchell S
MS
Chen
Allen R
AR
Davies
Stella M
SM
Frangoul
Haydar
H
Gajewski
James
J
Gale
Robert Peter
RP
Godder
Kamar
K
Hale
Gregory A
GA
Heemskerk
Martin B A
MB
Horan
John
J
Kamani
Naynesh
N
Kasow
Kimberly A
KA
Chan
Ka Wah
KW
Lee
Stephanie J
SJ
Leung
Wing H
WH
Lewis
Victor A
VA
Miklos
David
D
Oudshoorn
Machteld
M
Petersdorf
Effie W
EW
Ringdén
Olle
O
Sanders
Jean
J
Schultz
Kirk R
KR
Seber
Adriana
A
Setterholm
Michelle
M
Wall
Donna A
DA
Yu
Lolie
L
Pulsipher
Michael A
MA
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
D006680:HLA Antigens