TY - JOUR
T1 - Outcomes of pediatric bone marrow transplantation for leukemia and myelodysplasia using matched sibling, mismatched related, or matched unrelated donors
AU - Shaw, Peter J.
AU - Kan, Fangyu
AU - Ahn, Kwang Woo
AU - Spellman, Stephen R.
AU - Aljurf, Mahmoud
AU - Ayas, Mouhab
AU - Burke, Michael
AU - Cairo, Mitchell S.
AU - Chen, Allen R.
AU - Davies, Stella M.
AU - Frangoul, Haydar
AU - Gajewski, James
AU - Gale, Robert Peter
AU - Godder, Kamar
AU - Hale, Gregory A.
AU - Heemskerk, Martin B.A.
AU - Horan, John
AU - Kamani, Naynesh
AU - Kasow, Kimberly A.
AU - Chan, Ka Wah
AU - Lee, Stephanie J.
AU - Leung, Wing H.
AU - Lewis, Victor A.
AU - Miklos, David
AU - Oudshoorn, Machteld
AU - Petersdorf, Effie W.
AU - Ringdén, Olle
AU - Sanders, Jean
AU - Schultz, Kirk R.
AU - Seber, Adriana
AU - Setterholm, Michelle
AU - Wall, Donna A.
AU - Yu, Lolie
AU - Pulsipher, Michael A.
PY - 2010/11/11
Y1 - 2010/11/11
N2 - Although 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.
AB - Although 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.
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U2 - 10.1182/blood-2010-01-261958
DO - 10.1182/blood-2010-01-261958
M3 - Article
C2 - 20671124
AN - SCOPUS:78149432602
SN - 0006-4971
VL - 116
SP - 4007
EP - 4015
JO - Blood
JF - Blood
IS - 19
ER -