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Risks and Benefits of Unrelated Donor Peripheral Blood Progenitor Cell S (PBSC) in Children and Adolescents With Acute Leukemia

2009; Elsevier BV; Volume: 15; Issue: 2 Linguagem: Inglês

10.1016/j.bbmt.2008.12.065

1523-6536

Olle Ringdén, Mary Eapen, Franco Locatelli, R. E. Champlin, Haydar Frangoul, Mats Remberger, Adrian P. Gee, Mary J. Laughlin, Vanderson Rocha,

Neutropenia and Cancer Infections

PBPC is an acceptable alternative to bone marrow (BM) for transplanting children with leukemia. Children and adolescents with leukemia receiving PBSC compared to BM from HLA-identical sibling donors had more chronic graft-vs-host disease (GVHD), higher transplant-related mortality (TRM) and lower leukemia-free survival (LFS). We wanted to find out if children receiving unrelated donor grafts should be given BM rather than PBPC. Therefore, we compared the results of 385 unrelated donor BM transplants that were allele-matched (n = 186) or mismatched (n = 199) at HLA A, B, C, DRß1 and 110 PBPC transplants that were matched (n = 60) or mismatched (n = 50) at HLA A, B, C, DRß1 in patients younger than 18 years of age. All patients had acute leukemia and were transplanted in 2000–2006. Median follow-up of surviving patients was 2 years in both treatment groups. There were no significant differences in patient and disease characteristics, transplant conditioning regimen, GVHD prophylaxis and donor-recipient HLA disparity by graft type. Though the early probability of neutrophil recovery (≥500/ul) was faster after transplantation of PBPC (31% vs. 10% at day-14, p<0.001) the probability of recovery by day-28 was similar after PBPC and BM transplants (94% and 91%, p = 0.391). Platelet recovery (≥20,000/ul) was better after PBPC transplants (86% vs. 76% at day-60, p = 0.022). Risks of grade 2–4 (hazard ratio [HR] 1.24, p = 0.147) and grade 3–4 (HR 1.07, p = 0.785) acute GVHD were similar after PBPC and BM transplants. The risk of developing chronic GVHD was significantly greater after PBPC transplants compared to BM transplants (HR 2.36, p<0.001). After adjusting for disease status, donor-recipient HLA disparity and age, TRM, relapse, leukemia-free survival and overall survival were similar after PBPC and BM transplants. In parentheses is shown the day-100 probability of grade 2–4 acute GVHD (53%/49%) the 3-year probabilities of chronic GVHD (58%/33%), TRM (20%/24%), relapse (34%/28%), LFS (46%/48%) and overall survival (49%/49%) for the PBPC/BM groups, respectively. These results differ from transplantation of PBPC from HLA-matched siblings To conclude, in patients <18 years of age with acute leukemia, unrelated PBPC transplant compared to BM resulted in faster recovery of neutrophils and platelets and an increased risk of chronic GVHD. Acute GVHD, TRM, relapse, survival and LFS were similar using PBPC or BM.