Journal of Clinical Oncology, Vol 15, 557-565, Copyright © 1997 by American Society of Clinical Oncology

ARTICLES

Unrelated donor bone marrow transplantation for children with acute leukemia

SM Davies, JE Wagner, XO Shu, BR Blazar, E Katsanis, PJ Orchard, JH Kersey, KE Dusenbery, DJ Weisdorf, PB McGlave and NK Ramsay
Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA. davie008@maroon.tc.umn.edu

PURPOSE: To test the use of unrelated donor bone marrow transplantation (URD BMT) to cure children with high-risk acute leukemias. PATIENTS AND METHODS: Between June 1985 and December 1994, 50 children with acute leukemia (15 acute myelogenous leukemia [AML], 35 acute lymphoblastic leukemia [ALL]; 22 greater than second complete remission [CR]) received BMT from a URD at the University of Minnesota. Ages ranged from 0.9 to 17.5 years (median, 8.8). Median follow-up is 2.1 years (range, 1 to 7.3). Thirty patients (60%) received bone marrow fully matched at HLA-A,B and DRB1; 20 (40%) received bone marrow with a major or minor mismatch at a single HLA-A or B locus. RESULTS: The median time to neutrophil engraftment was day 24 (range, 14 to 42 days) in those receiving matched and day 25 (range, 15 to 32 days) in those receiving mismatched marrow (P = .35). The incidence of grades III to IV graft-versus-host disease (GVHD) was 23% (95% confidence interval [CI], 7% to 39%) in matched and 32% (95% CI, 8% to 52%) in HLA- mismatched patients (P = .57). The incidence of chronic GVHD was 50% (95% CI, 28% to 72%) in matched and 57% (95% CI, 23% to 91%) in mismatched patients (P = .80). Disease-free survival for patients with ALL is 37% (95% CI, 21% to 53%) at 1 year and 30% (95% CI, 15% to 46%) at 2 years; for patients with AML, 53% (95% CI, 28% to 78%) at 1 year and 33% (95% CI, 6% to 60%) at 2 years. CONCLUSION: URD BMT is an effective treatment for children with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended.

This article has been cited by other articles:

				G. Michel, V. Rocha, S. Chevret, W. Arcese, K.-W. Chan, A. Filipovich, T. A. Takahashi, M. Vowels, J. Ortega, P. Bordigoni, et al. Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord Group analysis Blood, December 15, 2003; 102(13): 4290 - 4297. [Abstract] [Full Text] [PDF]

				S. S. Grewal, J. N. Barker, S. M. Davies, and J. E. Wagner Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood? Blood, June 1, 2003; 101(11): 4233 - 4244. [Full Text] [PDF]

				N. Bunin, M. Carston, D. Wall, R. Adams, J. Casper, N. Kamani, R. King, and the National Marrow Donor Program Working Group Unrelated marrow transplantation for children with acute lymphoblastic leukemia in second remission Blood, May 1, 2002; 99(9): 3151 - 3157. [Abstract] [Full Text] [PDF]

				U. M. Saarinen-Pihkala, G. Gustafsson, O. Ringden, C. Heilmann, A. Glomstein, G. Lonnerholm, J. Abrahamsson, A. N. Bekassy, H. Schroeder, and L. Mellander No Disadvantage in Outcome of Using Matched Unrelated Donors as Compared With Matched Sibling Donors for Bone Marrow Transplantation in Children With Acute Lymphoblastic Leukemia in Second Remission J. Clin. Oncol., July 15, 2001; 19(14): 3406 - 3414. [Abstract] [Full Text] [PDF]

				D. Pinkel, W. G. Woods, B. J. Lange, F. O. Smith, and T. A. Alonzo Treatment of children with acute myeloid leukemia Blood, June 1, 2001; 97(11): 3673 - 3675. [Full Text] [PDF]

				B. G. Thomson, K. A. Robertson, D. Gowan, D. Heilman, H. E. Broxmeyer, D. Emanuel, P. Kotylo, Z. Brahmi, and F. O. Smith Analysis of engraftment, graft-versus-host disease, and immune recovery following unrelated donor cord blood transplantation Blood, October 15, 2000; 96(8): 2703 - 2711. [Abstract] [Full Text] [PDF]

				K. T. Godder, L. J. Hazlett, S. H. Abhyankar, K. Y. Chiang, N. P. Christiansen, K. D. Bridges, C. G. Lee, S. S. Geier, K. S. Goon-Johnson, A. P. Gee, et al. Partially Mismatched Related-Donor Bone Marrow Transplantation for Pediatric Patients With Acute Leukemia: Younger Donors and Absence of Peripheral Blasts Improve Outcome J. Clin. Oncol., May 9, 2000; 18(9): 1856 - 1866. [Abstract] [Full Text] [PDF]

				C. A. Felix, B. J. Lange, and J. M. Chessells Pediatric Acute Lymphoblastic Leukemia: Challenges and Controversies in 2000 Hematology, January 1, 2000; 2000(1): 285 - 302. [Abstract] [Full Text] [PDF]

				A. Green, E. Clarke, L. Hunt, A. Canterbury, A. Lankester, G. Hale, H. Waldmann, S. Goodman, J. M. Cornish, D. I. Marks, et al. Children With Acute Lymphoblastic Leukemia Who Receive T-Cell-Depleted HLA Mismatched Marrow Allografts From Unrelated Donors Have an Increased Incidence of Primary Graft Failure but a Similar Overall Transplant Outcome Blood, October 1, 1999; 94(7): 2236 - 2246. [Abstract] [Full Text] [PDF]

				C. A. Felix and B. J. Lange Leukemia in Infants Oncologist, June 1, 1999; 4(3): 225 - 240. [Abstract] [Full Text]

				F. Locatelli, V. Rocha, C. Chastang, W. Arcese, G. Michel, M. Abecasis, C. Messina, J. Ortega, I. Badell-Serra, E. Plouvier, et al. Factors Associated With Outcome After Cord Blood Transplantation in Children With Acute Leukemia Blood, June 1, 1999; 93(11): 3662 - 3671. [Abstract] [Full Text] [PDF]

				T.N. Small, E.B. Papadopoulos, F. Boulad, P. Black, H. Castro-Malaspina, B.H. Childs, N. Collins, A. Gillio, D. George, A. Jakubowski, et al. Comparison of Immune Reconstitution After Unrelated and Related T-Cell-Depleted Bone Marrow Transplantation: Effect of Patient Age and Donor Leukocyte Infusions Blood, January 15, 1999; 93(2): 467 - 480. [Abstract] [Full Text] [PDF]

				J. H. Kersey Fifty Years of Studies of the Biology and Therapy of Childhood Leukemia Blood, December 1, 1997; 90(11): 4243 - 4251. [Full Text] [PDF]