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Transplantation in Children and Adolescents with Acute Lymphoblastic Leukemia from a Matched Donor versus an HLA-Identical Sibling : Is the Outcome Comparable? Results from the International BFM ALL SCT 2007 Study

Balduzzi, Adriana ; Dalle, Jean Hugues ; Wachowiak, Jacek ; Yaniv, Isaac ; Yesilipek, Akif ; Sedlacek, Petr ; Bierings, Marc ; Ifversen, Marianne ; Sufliarska, Sabina and Kalwak, Krzysztof , et al. (2019) In Biology of Blood and Marrow Transplantation 25(11). p.2197-2210
Abstract

Eligibility criteria for hematopoietic stem cell transplantation (HSCT) in acute lymphoblastic leukemia (ALL) vary according to disease characteristics, response to treatment, and type of available donor. As the risk profile of the patient worsens, a wider degree of HLA mismatching is considered acceptable. A total of 138 children and adolescents who underwent HSCT from HLA-identical sibling donors (MSDs) and 210 who underwent HSCT from matched donors (MDs) (median age, 9 years; 68% male) in 10 countries were enrolled in the International-BFM ALL SCT 2007 prospective study to assess the impact of donor type in HSCT for pediatric ALL. The 4-year event-free survival (65 ± 5% vs 61 ± 4%; P =.287), overall survival (72 ± 4% versus 68 ± 4%;... (More)

Eligibility criteria for hematopoietic stem cell transplantation (HSCT) in acute lymphoblastic leukemia (ALL) vary according to disease characteristics, response to treatment, and type of available donor. As the risk profile of the patient worsens, a wider degree of HLA mismatching is considered acceptable. A total of 138 children and adolescents who underwent HSCT from HLA-identical sibling donors (MSDs) and 210 who underwent HSCT from matched donors (MDs) (median age, 9 years; 68% male) in 10 countries were enrolled in the International-BFM ALL SCT 2007 prospective study to assess the impact of donor type in HSCT for pediatric ALL. The 4-year event-free survival (65 ± 5% vs 61 ± 4%; P =.287), overall survival (72 ± 4% versus 68 ± 4%; P =.235), cumulative incidence of relapse (24 ± 4% versus 25 ± 3%; P =.658) and nonrelapse mortality (10 ± 3% versus 14 ± 3%; P =.212) were not significantly different between MSD and MD graft recipients. The risk of extensive chronic (cGVHD) was lower in MD graft recipients than in MSD graft recipients (hazard ratio [HR],.38; P =.002), and the risks of severe acute GVHD (aGVHD) and cGVHD were higher in peripheral blood stem cell graft recipients than in bone marrow graft recipients (HR, 2.06; P =.026). Compared with the absence of aGVHD, grade I-II aGVHD was associated with a lower risk of graft failure (HR,.63; P =.042) and grade III-IV aGVHD was associated with a higher risk of graft failure (HR, 1.85; P =.020) and nonleukemic death (HR, 8.76; P <.0001), despite a lower risk of relapse (HR,.32; P =.021). Compared with the absence of cGVHD, extensive cGVHD was associated with a higher risk of nonleukemic death (HR, 8.12; P <.0001). Because the outcomes of transplantation from a matched donor were not inferior to those of transplantation from an HLA-identical sibling, eligibility criteria for transplantation might be reviewed in pediatric ALL and possibly in other malignancies as well. Bone marrow should be the preferred stem cell source, and the addition of MTX should be considered in MSD graft recipients.

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type
Contribution to journal
publication status
published
subject
keywords
Acute lymphoblastic leukemia, Chronic graft-versus-host disease, Hematopoietic stem cell transplantation, Pediatric, Transplantation-related mortality
in
Biology of Blood and Marrow Transplantation
volume
25
issue
11
pages
14 pages
publisher
Elsevier
external identifiers
  • scopus:85071473419
  • pmid:31319153
ISSN
1083-8791
DOI
10.1016/j.bbmt.2019.07.011
language
English
LU publication?
no
id
4536b614-b0f3-40b9-82a3-91e1992907ee
date added to LUP
2020-04-23 09:20:58
date last changed
2024-07-24 17:26:35
@article{4536b614-b0f3-40b9-82a3-91e1992907ee,
  abstract     = {{<p>Eligibility criteria for hematopoietic stem cell transplantation (HSCT) in acute lymphoblastic leukemia (ALL) vary according to disease characteristics, response to treatment, and type of available donor. As the risk profile of the patient worsens, a wider degree of HLA mismatching is considered acceptable. A total of 138 children and adolescents who underwent HSCT from HLA-identical sibling donors (MSDs) and 210 who underwent HSCT from matched donors (MDs) (median age, 9 years; 68% male) in 10 countries were enrolled in the International-BFM ALL SCT 2007 prospective study to assess the impact of donor type in HSCT for pediatric ALL. The 4-year event-free survival (65 ± 5% vs 61 ± 4%; P =.287), overall survival (72 ± 4% versus 68 ± 4%; P =.235), cumulative incidence of relapse (24 ± 4% versus 25 ± 3%; P =.658) and nonrelapse mortality (10 ± 3% versus 14 ± 3%; P =.212) were not significantly different between MSD and MD graft recipients. The risk of extensive chronic (cGVHD) was lower in MD graft recipients than in MSD graft recipients (hazard ratio [HR],.38; P =.002), and the risks of severe acute GVHD (aGVHD) and cGVHD were higher in peripheral blood stem cell graft recipients than in bone marrow graft recipients (HR, 2.06; P =.026). Compared with the absence of aGVHD, grade I-II aGVHD was associated with a lower risk of graft failure (HR,.63; P =.042) and grade III-IV aGVHD was associated with a higher risk of graft failure (HR, 1.85; P =.020) and nonleukemic death (HR, 8.76; P &lt;.0001), despite a lower risk of relapse (HR,.32; P =.021). Compared with the absence of cGVHD, extensive cGVHD was associated with a higher risk of nonleukemic death (HR, 8.12; P &lt;.0001). Because the outcomes of transplantation from a matched donor were not inferior to those of transplantation from an HLA-identical sibling, eligibility criteria for transplantation might be reviewed in pediatric ALL and possibly in other malignancies as well. Bone marrow should be the preferred stem cell source, and the addition of MTX should be considered in MSD graft recipients.</p>}},
  author       = {{Balduzzi, Adriana and Dalle, Jean Hugues and Wachowiak, Jacek and Yaniv, Isaac and Yesilipek, Akif and Sedlacek, Petr and Bierings, Marc and Ifversen, Marianne and Sufliarska, Sabina and Kalwak, Krzysztof and Lankester, Arjan and Toporski, Jacek and Di Maio, Lucia and Glogova, Evgenia and Poetschger, Ulrike and Peters, Christina}},
  issn         = {{1083-8791}},
  keywords     = {{Acute lymphoblastic leukemia; Chronic graft-versus-host disease; Hematopoietic stem cell transplantation; Pediatric; Transplantation-related mortality}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{2197--2210}},
  publisher    = {{Elsevier}},
  series       = {{Biology of Blood and Marrow Transplantation}},
  title        = {{Transplantation in Children and Adolescents with Acute Lymphoblastic Leukemia from a Matched Donor versus an HLA-Identical Sibling : Is the Outcome Comparable? Results from the International BFM ALL SCT 2007 Study}},
  url          = {{http://dx.doi.org/10.1016/j.bbmt.2019.07.011}},
  doi          = {{10.1016/j.bbmt.2019.07.011}},
  volume       = {{25}},
  year         = {{2019}},
}