Children with acute leukemia: a comparison of outcomes from allogeneic blood stem cell and bone marrow transplantation.
BACKGROUND
The relative merits of peripheral blood stem-cell transplantation (PBSCT) versus bone marrow transplantation (BMT) for children with standard and high-risk hematologic malignancies remain unclear. In a retrospective study, we compared allogeneic PBSCT (n = 30) with BMT (n = 110) in children with acute leukemia between January 2001 and September 2006.


METHODS
Median age for PBSCT was 9 years versus 8 years for BMT. Descriptive statistics were used to summarize the demographic and medical variables. The unadjusted probabilities of disease-free survival were estimated using the Kaplan-Meier method. The association of graft-source and time to each of the study endpoints was estimated by Cox's regression model and the occurrence of graft-versus-host disease (GvHD) was included as a time-dependent covariate.


RESULTS
Time to neutrophil engraftment and platelet independence was faster after PBSCT than BMT (neutrophils 15.0 days vs. 17.0 days, P < 0.001; platelets, 21.0 days vs. 27.0 days, P = 0.034). The cumulative incidence of grades II-IV acute GvHD at 100 days was 10.4% (SE 5.6%) after PBSCT and 15.1% (SE 3.5%) after BMT (P = NS). The cumulative incidence of chronic GvHD was 13.8% (SE 6.3%) after PBSCT and 11.3% (SE 3.1%) after BMT (P = NS). One-year disease-free survival was 37.9% (SE 9.0%) for PBSCT recipients versus 65.1% (SE 4.6%) after BMT (P = 0.005) but this difference was not sustained in multivariate analysis. Thus, only disease risk and pre-transplant CMV seropositivity were significant predictors of disease-free survival.


CONCLUSIONS
We conclude that PBSCT for children produces faster engraftment without increased risk of acute or chronic GvHD.
Center for Cell and Gene Therapy, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA. yufengl@bcm.edu
Yu-Feng
YF
Lin
David R
DR
Lairson
Wenyaw
W
Chan
Xianglin L
XL
Du
Kathryn S
KS
Leung
Alana A
AA
Kennedy-Nasser
Caridad A
CA
Martinez
Helen E
HE
Heslop
Malcolm K
MK
Brenner
Robert A
RA
Krance
D000208:Acute Disease; D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease; D006410:Hematopoiesis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007700:Kinetics; D007938:Leukemia / Q000628:therapy*; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome