J Korean Med Sci.  2011 Dec;26(12):1548-1555. 10.3346/jkms.2011.26.12.1548.

Hematopoietic Stem Cell Transplantation in Children with Leukemia: A Single Institution Experience with Respect to Donors

Affiliations
  • 1Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.
  • 2Childhood Cancer Environmental Health Center, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.

Abstract

Aim of this study was to compare the outcomes of transplantation by donor source and to help select the best alternative donor in children with leukemia. Donor sources included matched related donor (MRD, n = 35), allele-matched unrelated donor (M-UD, n = 10) or -mismatched (MM)-UD (n = 13) or unrelated umbilical cord blood (UCB, n = 11). UCB group had a significantly higher incidence of grade II-IV acute graft versus host disease (MRD, 11.8%; M-UD, 30.0%; MM-UD, 15.4%, UCB, 54.4%, P = 0.004) but there was no difference in incidence of chronic graft versus host disease between 4 groups. The 5-yr leukemia-free survival (LFS) was 76.7%, 60.0%, 69.2%, and 45.5%, respectively (P = 0.128). MRD group showed higher LFS rate than UCB group (P = 0.022). However, LFS of M-UD and MM-UD together (65.2%) was not different from that of MRD group (76.7%, P = 0.325), or from that of UCB (45.5%, P = 0.190). The relapse incidence at 5 yr was 17.1%, 20.0%, 15.4%, and 0%, respectively (P = 0.460). The 100-day treatment-related mortality was 2.9%, 20.0%, 7.7%, and 36.4%, respectively (P = 0.011). Despite the limitations of small number of patients, unrelated donor transplants including even allele-mismatched ones, seem to be as effective in children with leukemia lacking suitable relative donors. Also, UCB transplant may serve as another possible option in urgent transplants.

Keyword

Allogeneic Hematopoietic Stem Cell Transplantation; Leukemia; Unrelated Donor; Umbilical Cord Blood

MeSH Terms

Adolescent
Child
Child, Preschool
*Cord Blood Stem Cell Transplantation/adverse effects/methods
Disease-Free Survival
Female
Fetal Blood/transplantation
Graft vs Leukemia Effect
*Hematopoietic Stem Cell Transplantation/adverse effects/methods/mortality
Histocompatibility Testing
Humans
Infant
Leukemia/mortality/*therapy
Male
Transplantation, Homologous
Treatment Outcome
Unrelated Donors

Figure

  • Fig. 1 Probability of Kaplan-Meier 5-yr overall survival (A) and leukemic-free survival (B) by different donor groups.


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