Hematopoietic stem cell transplantation in children with acute leukemia: similar outcomes in recipients of umbilical cord blood versus marrow or peripheral blood stem cells from related or unrelated donors.
- Author:
Eun Sang YI
1
;
Soo Hyun LEE
;
Meong Hi SON
;
Ju Youn KIM
;
Eun Joo CHO
;
Su Jin LIM
;
Hee Won CHEUH
;
Keon Hee YOO
;
Ki Woong SUNG
;
Hong Hoe KOO
Author Information
- Publication Type:Original Article
- Keywords: Umbilical cord blood; Hematopoietic stem cell transplantation; Stem cell donor
- MeSH: Blood Platelets; Bone Marrow; Child; Disease-Free Survival; Fetal Blood; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cells; Humans; Leukemia; Leukocytes; Multivariate Analysis; Neutrophils; Recurrence; Retrospective Studies; Stem Cells; Tissue Donors; Transplants; Umbilical Cord; Unrelated Donors; Whole-Body Irradiation
- From:Korean Journal of Pediatrics 2012;55(3):93-99
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: This study compared outcomes in children with acute leukemia who underwent transplantations with umbilical cord blood (UCB), bone marrow, or peripheral blood stem cells from a human leukocyte antigen (HLA)-matched related donor (MRD) or an unrelated donor (URD). METHODS: This retrospective study included consecutive acute leukemia patients who underwent their first allogeneic hematopoietic stem cell transplantation (HSCT) at Samsung Medical Center between 2005 and 2010. Patients received stem cells from MRD (n=33), URD (n=46), or UCB (n=41). RESULTS: Neutrophil and platelet recovery were significantly longer after HSCT with UCB than with MRD or URD (P<0.01 for both). In multivariate analysis using the MRD group as a reference, the URD group had a significantly higher risk of grade III to IV acute graft-versus-host disease (GVHD; relative risk [RR], 15.2; 95% confidence interval [CI], 1.2 to 186.2; P=0.03) and extensive chronic GVHD (RR, 6.9; 95% CI, 1.9 to 25.2; P<0.01). For all 3 donor types, 5-year event-free survival (EFS) and overall survival were similar. Extensive chronic GVHD was associated with fewer relapses (RR, 0.1; 95% CI, 0.04 to 0.6; P<0.01). Multivariate analysis showed that lower EFS was associated with advanced disease at transplantation (RR, 3.2; 95% CI, 1.3 to 7.8; P<0.01) and total body irradiation (RR, 2.1; 95% CI, 1.0 to 4.3; P=0.04). CONCLUSION: Survival after UCB transplantation was similar to survival after MRD and URD transplantation. For patients lacking an HLA matched donor, the use of UCB is a suitable alternative.
