title: PBSCT is associated with poorer survival and increased chronic GvHD than BMT in Japanese paediatric patients with acute leukaemia and an HLA-matched sibling donor.
abstract: BACKGROUND
  Peripheral blood stem cells (PBSC) may be used as an alternative to bone marrow (BM) for allogeneic transplantation. Since peripheral blood stem cell bank from unrelated volunteer donor has been started in Japan, use of PBSC allografts may be increased. Therefore we surveyed the outcomes of Japanese leukemia children after PBSC and BM transplantation.
  
  
  METHODS
  This retrospective study compared the outcomes of 661 children (0-18 years) with acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML) who received their first allogeneic peripheral blood stem cell transplantation (PBSCT; n = 90) or bone marrow transplantation (BMT; n = 571) from HLA-matched siblings between January 1996 and December 2007.
  
  
  RESULTS
  Neutrophil recovery was faster after PBSCT than after BMT (ALL: P < 0.0001; AML: P = 0.0002), as was platelet recovery (ALL: P = 0.0008; AML: P = 0.0848). However, the cumulative incidence of chronic graft-versus-host disease (GvHD) was higher after PBSCT than after BMT (ALL: 26.0% vs. 9.9%, P = 0.0066; AML: 41.6% vs. 11.1%, P < 0.0001). The 5-year disease-free survival (DFS) was lower after PBSCT than after BMT for ALL (40.6% vs. 57.1%, P = 0.0257). The 5-year overall survival (OS) was lower after PBSCT than after BMT for ALL (42.4% vs. 63.7%, P = 0.0032) and AML (49.8% vs. 71.8%, P = 0.0163). Multivariate analysis revealed the use of PBSC was a significant risk factor for DFS and OS. PBSCT and BMT did not differ in relapse rate, acute GvHD for ALL and AML, or in DFS for AML.
  
  
  CONCLUSIONS
  PBSC allografts in Japanese children engraft faster but are associated with poorer survival and increased chronic GvHD.
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Shinzato
authors.forename: Ken
authors.initials: K
authors.lastname: Tabuchi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.forename: Masami
authors.initials: M
authors.lastname: Inoue
authors.forename: Jiro
authors.initials: J
authors.lastname: Inagaki
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Yabe
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Koh
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ohta
authors.forename: Hisato
authors.initials: H
authors.lastname: Kigasawa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kitoh
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogawa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yoji
authors.initials: Y
authors.lastname: Sasahara
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Kato
authors.forename: Souichi
authors.initials: S
authors.lastname: Adachi
mesh_terms: D000293:Adolescent; D044466:Asian People; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D019520:Living Donors; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D035781:Siblings; D015996:Survival Rate; D014184:Transplantation, Homologous
keywords: acute leukaemia; bone marrow transplantation; children; chronic graft-versus-host disease; peripheral blood stem cell transplantation