Korean J Pediatr.  2012 Mar;55(3):93-99. 10.3345/kjp.2012.55.3.93.

Hematopoietic stem cell transplantation in children with acute leukemia: similar outcomes in recipients of umbilical cord blood versus marrow or peripheral blood stem cells from related or unrelated donors

• Yi ES
• Lee SH
• Son MH
• Kim JY
• Cho EJ
• Lim SJ
• Cheuh HW
• Yoo KH
• Sung KW
• Koo HH

• KMID: 2284315
• DOI: http://doi.org/10.3345/kjp.2012.55.3.93

Abstract

PURPOSE
This study compared outcomes in children with acute leukemia who underwent transplantations with umbilical cord blood (UCB), bone marrow, or peripheral blood stem cells from a human leukocyte antigen (HLA)-matched related donor (MRD) or an unrelated donor (URD).
METHODS
This retrospective study included consecutive acute leukemia patients who underwent their first allogeneic hematopoietic stem cell transplantation (HSCT) at Samsung Medical Center between 2005 and 2010. Patients received stem cells from MRD (n=33), URD (n=46), or UCB (n=41).
RESULTS
Neutrophil and platelet recovery were significantly longer after HSCT with UCB than with MRD or URD (P<0.01 for both). In multivariate analysis using the MRD group as a reference, the URD group had a significantly higher risk of grade III to IV acute graft-versus-host disease (GVHD; relative risk [RR], 15.2; 95% confidence interval [CI], 1.2 to 186.2; P=0.03) and extensive chronic GVHD (RR, 6.9; 95% CI, 1.9 to 25.2; P<0.01). For all 3 donor types, 5-year event-free survival (EFS) and overall survival were similar. Extensive chronic GVHD was associated with fewer relapses (RR, 0.1; 95% CI, 0.04 to 0.6; P<0.01). Multivariate analysis showed that lower EFS was associated with advanced disease at transplantation (RR, 3.2; 95% CI, 1.3 to 7.8; P<0.01) and total body irradiation (RR, 2.1; 95% CI, 1.0 to 4.3; P=0.04).
CONCLUSION
Survival after UCB transplantation was similar to survival after MRD and URD transplantation. For patients lacking an HLA matched donor, the use of UCB is a suitable alternative.

Keyword

Umbilical cord blood; Hematopoietic stem cell transplantation; Stem cell donor

MeSH Terms

Blood Platelets
Bone Marrow
Child
Disease-Free Survival
Fetal Blood
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Leukemia
Leukocytes
Multivariate Analysis
Neutrophils
Recurrence
Retrospective Studies
Stem Cells
Tissue Donors
Transplants
Umbilical Cord
Unrelated Donors
Whole-Body Irradiation