Outcomes of pediatric bone marrow transplantation for leukemia and myelodysplasia using matched sibling, mismatched related, or matched unrelated donors

Blood - Tập 116 - Trang 4007-4015 - 2010
Peter J. Shaw1, Fangyu Kan2, Kwang Woo Ahn3, Stephen R. Spellman2, Mahmoud Aljurf4, Mouhab Ayas4, Michael Burke5, Mitchell S. Cairo6, Allen R. Chen7, Stella M. Davies8, Haydar Frangoul9, James Gajewski10, Robert Peter Gale11, Kamar Godder12, Gregory A. Hale13, Martin B.A. Heemskerk14, John Horan15, Naynesh Kamani16, Kimberly A. Kasow17, Ka Wah Chan18
1Children’s Hospital at Westmead, Sydney, Australia
2National Marrow Donor Program, Minneapolis, MN
3Medical College of Wisconsin, Milwaukee, WI
4King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
5University of Minnesota, Minneapolis, MN
6Columbia University, New York, NY
7Johns Hopkins University, Baltimore, MD
8Cincinnati Children's Hospital Medical Center, Cincinnati, OH
9Vanderbilt Children's Hospital, Nashville, TN
10Oregon Health & Science University, Portland, OR
11Celgene Corp, Summit, NJ;
12Children's Medical Center, Virginia Commonwealth Health Systems, Richmond, VA;
13All Children’s Hospital, St. Petersburg, FL
14Dutch Transplant Foundation, Leiden, The Netherlands
15Emory University, Atlanta, GA
16Children's National Medical Center, Washington, DC
17The University of North Carolina at Chapel Hill, Chapel Hill, NC
18Texas Transplant Institute, San Antonio, TX

Tóm tắt

AbstractAlthough some trials have allowed matched or single human leukocyte antigen (HLA)–mismatched related donors (mmRDs) along with HLA-matched sibling donors (MSDs) for pediatric bone marrow transplantation in early-stage hematologic malignancies, whether mmRD grafts lead to similar outcomes is not known. We compared patients < 18 years old reported to the Center for International Blood and Marrow Transplant Research with acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and myelodysplastic syndrome undergoing allogeneic T-replete, myeloablative bone marrow transplantation between 1993 and 2006. In total, patients receiving bone marrow from 1208 MSDs, 266 8/8 allelic-matched unrelated donors (URDs), and 151 0-1 HLA-antigen mmRDs were studied. Multivariate analysis showed that recipients of MSD transplants had less transplantation-related mortality, acute graft-versus-host disease (GVHD), and chronic GVHD, along with better disease-free and overall survival than the URD and mmRD groups. No differences were observed in transplant-related mortality, acute and chronic GVHD, relapse, disease-free survival, or overall survival between the mmRD and URD groups. These data show that mmRD and 8/8 URD outcomes are similar, whereas MSD outcomes are superior to the other 2 sources. Whether allele level typing could identify mmRD recipients with better outcomes will not be known unless centers alter practice and type mmRD at the allele level.

Tài liệu tham khảo

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Blood

Tập 116

4007-4015

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