title: Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation - A comparison of the last two decades.
abstract: Pediatric protocols for allogeneic hematopoietic SCT have been altered during the last two decades. To compare the outcomes in children (<18 yr old), who underwent SCT at our center during 1992-2002 (P1) and 2003-2013 (P2). We retrospectively analyzed 188 patients in P1 and 201 patients in P2. The most significant protocol changes during P2 compared with P1 were a decrease in MAC protocols, particularly those containing TBI, an increase in RIC protocols, and altered GvHD prophylaxis. In addition, P2 had more patients with nonmalignant diagnoses (p = 0.002), more mismatched (MM) donors (p = 0.01), and more umbilical CB grafts (p = 0.03). Mesenchymal or DSCs were used for severe acute GvHD during P2. Three-yr OS in P1 was 58%, and in P2, it was 78% (p < 0.001). Improved OS was seen in both malignant disorders (51% vs. 68%; p = 0.05) and nonmalignant disorders (77% vs. 87%; p = 0.04). Multivariate analysis showed that SCT during P2 was associated with reduced mortality (HR = 0.57; p = 0.005), reduced TRM (HR = 0.57; p = 0.03), unchanged relapse rate, similar rate of GF, less chronic GvHD (HR = 0.49; p = 0.01), and more acute GvHD (HR = 1.77, p = 0.007). During recent years, OS has improved at our center, possibly reflecting the introduction of less toxic conditioning regimens and a number of other methodological developments in SCT.
authors.affiliation: Oncology/Coagulation Section, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Svenberg
authors.affiliation: Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden.|Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
authors.affiliation: Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uzunel
authors.affiliation: Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden.|Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Mattsson
authors.affiliation: Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.|Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
authors.forename: Britt
authors.initials: B
authors.lastname: Gustafsson
authors.affiliation: Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gustav
authors.initials: G
authors.lastname: Fjaertoft
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.|Hematology/Immunology Section, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Sundin
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.|Hematology/Immunology Section, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jacek
authors.initials: J
authors.lastname: Winiarski
authors.affiliation: Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
mesh_terms: D002648:Child; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D012008:Recurrence; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
keywords: allogeneic stem cell transplantation; pediatric hematopoietic stem cell; survival