Tags

Type your tag names separated by a space and hit enter

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.

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 mean 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.

Authors+Show Affiliations

Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy. Electronic address: abalduzzi@fondazionembbm.it.Hemato-Immunology Department, Robert-Debre Hospital, APHP and Paris-Diderot University, Paris, France.Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland.Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Antalya Medicalpark Hospital, Pediatric Stem Cell Transplantation Unit, Antalya, Turkey.Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic.Princess Maxima Centre for Pediatric Oncology and Utrecht University Children's Hospital, Utrecht, The Netherlands.Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.Bone Marrow Transplantation Unit, Bratislava, Slovakia.Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland.Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.Children's Hospital, Skåne University Hospital, Lund, Sweden.Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy.St Anna Children's Hospital, UKKJ, MUW, Vienna, Austria.St Anna Children's Hospital, UKKJ, MUW, Vienna, Austria.St Anna Children's Hospital, UKKJ, MUW, Vienna, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31319153

Citation

Balduzzi, Adriana, et al. "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." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 2019.
Balduzzi A, Dalle JH, Wachowiak J, et al. 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. Biol Blood Marrow Transplant. 2019.
Balduzzi, A., Dalle, J. H., Wachowiak, J., Yaniv, I., Yesilipek, A., Sedlacek, P., ... Peters, C. (2019). 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. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, doi:10.1016/j.bbmt.2019.07.011.
Balduzzi A, et al. 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. Biol Blood Marrow Transplant. 2019 Jul 15; PubMed PMID: 31319153.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Balduzzi,Adriana, AU - Dalle,Jean-Hugues, AU - Wachowiak,Jacek, AU - Yaniv,Isaac, AU - Yesilipek,Akif, AU - Sedlacek,Petr, AU - Bierings,Marc, AU - Ifversen,Marianne, AU - Sufliarska,Sabina, AU - Kalwak,Krzysztof, AU - Lankester,Arjan, AU - Toporski,Jacek, AU - Maio,Lucia Di, AU - Glogova,Evgenia, AU - Poetschger,Ulrike, AU - Peters,Christina, Y1 - 2019/07/15/ PY - 2019/02/07/received PY - 2019/07/07/revised PY - 2019/07/08/accepted PY - 2019/7/19/pubmed PY - 2019/7/19/medline PY - 2019/7/19/entrez KW - Acute lymphoblastic leukemia KW - Chronic graft-versus-host disease KW - Hematopoietic stem cell transplantation KW - Pediatric KW - Transplantation-related mortality JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol. Blood Marrow Transplant. N2 - 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 mean 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. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/31319153/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 L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(19)30443-4 DB - PRIME DP - Unbound Medicine ER -