TY - JOUR
T1 - Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia
AU - Rocha, Vanderson
AU - Cornish, Jacqueline
AU - Sievers, Eric L.
AU - Filipovich, Alexandra
AU - Locatelli, Franco
AU - Peters, Cristina
AU - Remberger, Mats
AU - Michel, Gérard
AU - Arcese, William
AU - Dallorso, Sandro
AU - Tiedemann, Karin
AU - Busca, Alessandro
AU - Chan, Ka-Wah
AU - Kato, Shunichi
AU - Ortega, Juan
AU - Vowels, Marcus
AU - Zander, Axel
AU - Souillet, Gérard
AU - Oakill, Anthony
AU - Woolfrey, Ann
AU - Pay, Andrea L.
AU - Green, Ann
AU - Gamier, Federico
AU - Ionescu, Irina
AU - Wernet, Peter
AU - Sirchia, Girolamo
AU - Rubinstein, Pablo
AU - Chevret, Sylvie
AU - Gluckman, Eliane
PY - 2001
Y1 - 2001
N2 - 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. (Blood. 2001;97:2962-2971) (C) 2001 by The American Society of Hematology.
AB - 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. (Blood. 2001;97:2962-2971) (C) 2001 by The American Society of Hematology.
KW - Hematopoietic Stem Cell Transplantation
KW - Hematopoietic Stem Cell Transplantation
UR - http://hdl.handle.net/10807/262660
U2 - 10.1182/blood.v97.10.2962
DO - 10.1182/blood.v97.10.2962
M3 - Article
SN - 0006-4971
VL - 97
SP - 2962
EP - 2971
JO - Blood
JF - Blood
ER -