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Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia

Rocha, Vanderson ; Cornish, Jacqueline ; Sievers, Eric L. ; Filipovich, Alexandra ; Locatelli, Franco ; Peters, Cristina ; Remberger, Mats ; Michel, Gérard ; Arcese, William ; Dallorso, Sandro ; Tiedemann, Karin ; Busca, Alessandro ; Chan, Ka-Wah ; Kato, Shunichi ; Ortega, Juan ; Vowels, Marcus ; Zander, Axel ; Souillet, Gérard ; Oakill, Anthony ; Woolfrey, Ann ; Pay, Andrea L. ; Green, Ann ; Garnier, Federico ; Ionescu, Irina ; Wernet, Peter ; Sirchia, Girolamo ; Rubinstein, Pablo ; Chevret, Sylvie ; Gluckman, Eliane

Blood, 2001-05, Vol.97 (10), p.2962-2971 [Periódico revisado por pares]

Washington, DC: Elsevier Inc

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Título:
Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia
Autor: Rocha, Vanderson ; Cornish, Jacqueline ; Sievers, Eric L. ; Filipovich, Alexandra ; Locatelli, Franco ; Peters, Cristina ; Remberger, Mats ; Michel, Gérard ; Arcese, William ; Dallorso, Sandro ; Tiedemann, Karin ; Busca, Alessandro ; Chan, Ka-Wah ; Kato, Shunichi ; Ortega, Juan ; Vowels, Marcus ; Zander, Axel ; Souillet, Gérard ; Oakill, Anthony ; Woolfrey, Ann ; Pay, Andrea L. ; Green, Ann ; Garnier, Federico ; Ionescu, Irina ; Wernet, Peter ; Sirchia, Girolamo ; Rubinstein, Pablo ; Chevret, Sylvie ; Gluckman, Eliane
Assuntos: Analysis of Variance ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Bone Marrow Transplantation ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Child ; Child, Preschool ; Disease-Free Survival ; Female ; Fetal Blood - cytology ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia - surgery ; Leukemia, Myeloid, Acute - mortality ; Leukemia, Myeloid, Acute - surgery ; Male ; Medical sciences ; Medicin och hälsovetenskap ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery ; Recurrence ; Registries ; Retrospective Studies ; Tissue Donors ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation Conditioning ; Treatment Outcome
É parte de: Blood, 2001-05, Vol.97 (10), p.2962-2971
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: In order to compare the outcomes of unrelated umbilical cord blood transplants (UCBTs) or bone marrow transplants, 541 children with acute leukemia (AL) transplanted with umbilical cord blood (n = 99), T-cell–depleted unrelated bone marrow transplants (T-UBMT) (n = 180), or nonmanipulated (UBMT) (n = 262), were analyzed in a retrospective multicenter study. Comparisons were performed after adjustment for patient, disease, and transplant variables. The major difference between the 3 groups was the higher number in the UCBT group of HLA mismatches (defined by serology for class I and molecular typing for DRB1). The donor was HLA mismatched in 92% of UCBTs, in 18% of UBMTs, and in 43% of T-UBMTs (P < .001). Other significant differences were observed in pretransplant disease characteristics, preparative regimens, graft-versus-host disease (GVHD) prophylaxis, and number of cells infused. Nonadjusted estimates of 2-year survival and event-free survival rates were 49% and 43%, respectively, in the UBMT group, 41% and 37% in the T-UBMT group, and 35% and 31% in the UCBT group. After adjustment, differences in outcomes appeared in the first 100 days after the transplantation. Compared with UBMT recipients, UCBT recipients had delayed hematopoietic recovery (Hazard ratio [HR] = 0.37; 95% confidence interval [95CI]: 0.27-0.52; P < .001), increased 100 day transplant-related mortality (HR = 2.13; 95CI: 1.20-3.76;P < .01) and decreased acute graft-versus-host disease (aGVHD) (HR = 0.50; 95CI: 0.34-0.73; P < .001). T-UBMT recipients had decreased aGVHD (HR = 0.25; 95CI: 0.17-0.36;P < .0001) and increased risk of relapse (HR = 1.96; 95CI: 1.11-3.45; P = .02). After day 100 posttransplant, the 3 groups achieved similar results in terms of relapse. Chronic GVHD was decreased after T-UBMT (HR = 0.21; 95CI: 0.11-0.37;P < .0001) and UCBT (HR = 0.24; 95CI: 0.01-0.66;P = .002), and overall mortality was higher in T-UBMT recipients (HR = 1.39; 95CI: 0.97-1.99; P < .07). In conclusion, the use of UCBT, as a source of hematopoietic stem cells, is a reasonable option for children with AL lacking an acceptably matched unrelated marrow donor.
Editor: Washington, DC: Elsevier Inc
Idioma: Inglês

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Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia

Washington, DC: Elsevier Inc

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