Comparison of Donor Sources in Hematopoietic Stem Cell Transplantation for Childhood Acute Leukemia: A Nationwide Retrospective Study.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the best therapeutic option for childhood high-risk acute leukemia. However, which donor source is optimal for children lacking an identical sibling remains unclear. To evaluate the clinical impact of donor source on allo-HSCT in childhood acute leukemia, we analyzed data from 577 children who underwent allo-HSCT after a myeloablative regimen during first or second complete remission from 2005 to 2012, using registry data of the Japan Society for Hematopoietic Cell Transplantation, and we compared outcomes of 7/8 to 8/8 HLA allelic-matched unrelated bone marrow transplantation (UR-BMT, n = 218) and 4/6 to 6/6 HLA allelic-matched unrelated cord blood transplantation (UR-CBT, n = 200) to those of HLA-identical related bone marrow transplantation (ID-BMT, n = 159). The median follow-up of survivors was 40.0 months. Three-year overall survival (OS) and leukemia-free survival (LFS) rates for ID-BMT, UR-BMT, and UR-CBT were 74.8% and 69.0%, 75.0% and 69.6%, and 71.8% and 63.8%, respectively. The multivariate analysis demonstrated that OS and LFS for the 3 groups are comparable, although UR-CBT carries a greater risk of nonrelapse mortality (hazard ratio, 2.20; P = .03, compared to ID-BMT) in the myeloablative setting for childhood high-risk acute leukemia.
Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan. Electronic address: sakaguchi_h@nagoya-1st.jrc.or.jp.
Hirotoshi
H
Sakaguchi
Department of Pediatrics, Meitestu Hospital, Nagoya, Japan.
Nobuhiro
N
Watanabe
Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
Kimikazu
K
Matsumoto
Department of Cell Transplantation and Regeneration Medicine, Tokai University School of Medicine, Isehara, Japan.
Hiromasa
H
Yabe
Department of Cell Transplantation and Regeneration Medicine, Tokai University School of Medicine, Isehara, Japan.
Shunichi
S
Kato
Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan.
Atsushi
A
Ogawa
Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan.
Jiro
J
Inagaki
Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan.
Hiroaki
H
Goto
Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.
Katsuyoshi
K
Koh
Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Nao
N
Yoshida
Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan.
Keisuke
K
Kato
Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.
Yuko
Y
Cho
Department of Hematology and Oncology, Children's Cancer Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
Yoshiyuki
Y
Kosaka
Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yoshiyuki
Y
Takahashi
Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
Masami
M
Inoue
Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Koji
K
Kato
Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yoshiko
Y
Atsuta
Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Koichi
K
Miyamura
D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality*; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D019653:Myeloablative Agonists / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D061349:Unrelated Donors
D019653:Myeloablative Agonists
Alternative donor; Childhood acute leukemia; Nationwide study