title: Comparison of outcomes after HLA-matched sibling and unrelated donor transplantation for children with high-risk acute lymphoblastic leukemia.
abstract: We compared outcomes after 94 HLA-matched sibling, 168 unrelated donor bone marrow (BM; n = 81 matched and n = 88 mismatched), and 86 cord blood transplantations in patients age 1 to 15 years with acute lymphoblastic leukemia (ALL) in second complete remission (CR). All patients had their first BM relapse within 3 years from diagnosis. Cox regression models were constructed to examine for differences in transplant outcome by donor source. Risks of grade 2 to 4 acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD), when compared to HLA-matched sibling transplants, were higher after matched unrelated donor BM (relative risk [RR], 2.42; P = .001; RR, 5.12; P < .001, respectively), mismatched BM (RR, 3.24; P < .001; RR, 5.19; P < .001, respectively), and cord blood (RR, 2.67; P < .001; RR, 2.54; P = .024, respectively) transplants. Although nonrelapse mortality was higher after transplantation of mismatched unrelated donor BM and cord blood, there were no differences in leukemia-free survival (LFS) between HLA-matched sibling and any of the unrelated donor transplantations. The 3-year probabilities of LFS were 50% after HLA-matched sibling and 44% after matched unrelated BM, and 44% after mismatched unrelated BM and 43% after cord blood transplantation. Our observations support transplantation of BM or cord blood from a suitably matched unrelated donor or cord blood for patients without an HLA-matched sibling with ALL in second CR.
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Camitta
authors.forename: Brent
authors.initials: B
authors.lastname: Logan
authors.forename: Karin
authors.initials: K
authors.lastname: Tiedemann
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Thiel
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D015234:HLA-A Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology* / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D035781:Siblings; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: D015234:HLA-A Antigens