Children with acute leukemia: A comparison of outcomes from allogeneic blood stem cell and bone marrow transplantation

Yu Feng Lin, David R. Lairson, Wenyaw Chan, Xianglin L. Du, Kathryn S. Leung, Alana A. Kennedy-Nasser, Caridad A. Martinez, Helen E. Heslop, Malcolm K. Brenner, Robert A. Krance

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background: The relative merits of peripheral blood stem-cell transplantation (PBSCT) versus bone marrow transplantation (BMT) for children with standard and high-risk hematologic malignancies remain unclear. In a retrospective study, we compared allogeneic PBSCT (n = 30) with BMT (n = 110) in children with acute leukemia between January 2001 and September 2006. Procedure: Median age for PBSCT was 9 years versus 8 years for BMT. Descriptive statistics were used to summarize the demographic and medical variables. The unadjusted probabilities of disease-free survival were estimated using the Kaplan-Meier method. The association of graft-source and time to each of the study endpoints was estimated by Cox's regression model and the occurrence of graft-versus-host disease (GvHD) was included as a time-dependent covariate. Results: Time to neutrophil engraftment and platelet independence was faster after PBSCT than BMT (neutrophils 15.0 days vs. 17.0 days, P < 0.001; platelets, 21.0 days vs. 27.0 days, P = 0.034). The cumulative incidence of grades II-IV acute GvHD at 100 days was 10.4% (SE 5.6%) after PBSCT and 15.1% (SE 3.5%) after BMT (P = NS). The cumulative incidence of chronic GvHD was 13.8% (SE 6.3%) after PBSCT and 11.3% (SE 3.1%) after BMT (P = NS). One-year disease-free survival was 37.9% (SE 9.0%) for PBSCT recipients versus 65.1% (SE 4.6%) after BMT (P = 0.005) but this difference was not sustained in multivariate analysis. Thus, only disease risk and pre-transplant CMV seropositivity were significant predictors of disease-free survival. Conclusions: We conclude that PBSCT for children produces faster engraftment without increased risk of acute or chronic GvHD.

Original languageEnglish (US)
Pages (from-to)143-151
Number of pages9
JournalPediatric Blood and Cancer
Volume56
Issue number1
DOIs
StatePublished - Jan 2011

Keywords

  • Acute leukemia
  • BMT
  • Stem-cell transplantation

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

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