Originally published as JCO Early Release 10.1200/JCO.2004.02.189 on November 1 2004

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Higher Mortality After Allogeneic Peripheral-Blood Transplantation Compared With Bone Marrow in Children and Adolescents: The Histocompatibility and Alternate Stem Cell Source Working Committee of the International Bone Marrow Transplant Registry

From the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI; The University of Texas M.D. Anderson Cancer Center, Houston, TX; the Karolinska Institutet, Stockholm, Sweden; and the University of Minnesota School of Medicine, Minneapolis, MN.

Address reprint requests to Mary Eapen, MBBS, MS, at the IBMTR/ABMTR Statistical Center, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226; e-mail: meapen{at}mail.mcw.edu

PURPOSE: Peripheral-blood stem cells (PBSC) may be used as an alternative to bone marrow (BM) for allogeneic transplantation. Despite lack of data on PBSC transplantation in children, there has been a change in clinical practice, with increasing numbers of children receiving PBSC allografts.

PATIENTS AND METHODS: We compared the results of 143 PBSC and 630 BM transplants from human leukocyte antigen–identical sibling donors in children aged 8 to 20 years with acute leukemia. PBSC transplant recipients were older, and were more likely to have advanced leukemia, receive growth factors post-transplantation, and have undergone transplantation more recently. Risks of acute and chronic graft-versus-host disease (GVHD), treatment-related mortality, relapse, treatment failure (relapse or death), and overall mortality were compared using Cox proportional hazards regression to adjust for potentially confounding factors.

RESULTS: Hematopoietic recovery was faster after PBSC transplantation. Risks of grade 2 to 4 acute GVHD were similar, but chronic GVHD risk was higher after PBSC transplantation (relative risk [RR], 1.85; 95% CI, 1.28 to 2.66; P = .001). In contrast to reports in adults, treatment-related mortality (RR, 1.89; 95% CI, 1.28 to 2.80; P = .001), treatment failure (RR, 1.31; 95% CI, 1.03 to 1.68; P = .03), and mortality (RR, 1.38; 95% CI, 1.07 to 1.79; P = .01) were higher after PBSC transplantation. Risks of relapse were similar.

CONCLUSION: These data suggest poorer outcomes after PBSC compared with BM transplantation in children after adjusting for relevant risk factors. Given the trend toward increased use of PBSC allografts in children, prospective clinical trials are required to determine their appropriate role in this group of patients.

Supported by Public Health Service Grant U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute, and a Clinical Research Career Development Award from the American Society of Clinical Oncology (M.E.).

Presented in part at the Annual Meeting of the American Society of Hematology, Philadelphia, PA, December 6-10, 2002.

Permission to publish: The Human Research Review Committee (HRRC) of the Medical College of Wisconsin, Milwaukee, U.S.A, has approve these data for analysis and publication (HRRC# 056-87).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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• Allogeneic Peripheral Blood Versus Bone Marrow Transplantation: Children Are Small Adults and More
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  JCO 2004 22: 4865-4866 [Full Text]

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