Factors Associated With Outcome After Cord Blood Transplantation in Children With Acute Leukemia

We have analyzed factors influencing the outcome of 102 children with acute leukemia given a cord blood transplantation (CBT) and reported to the Eurocord Registry. Seventy patients with acute lymphoblastic and 32 with acute myeloid leukemia were given either a related (n = 42) or an unrelated (n =...

Full description

Saved in:
Bibliographic Details
Published in:Blood 1999-06, Vol.93 (11), p.3662-3671
Main Authors: Locatelli, Franco, Rocha, Vanderson, Chastang, Claude, Arcese, William, Michel, Gerard, Abecasis, Manoel, Messina, Chiara, Ortega, Juan, Badell-Serra, Isabel, Plouvier, Emanuel, Souillet, Gerard, Jouet, Jean-Pierre, Pasquini, Ricardo, Ferreira, Euripedes, Garnier, Federico, Gluckman, Eliane
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bone marrow, stem cells transplantation. Graft versus host reaction
Medical sciences
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We have analyzed factors influencing the outcome of 102 children with acute leukemia given a cord blood transplantation (CBT) and reported to the Eurocord Registry. Seventy patients with acute lymphoblastic and 32 with acute myeloid leukemia were given either a related (n = 42) or an unrelated (n = 60) CBT. Children given CBT during first or second complete remission were considered as belonging to the good-risk group (n = 66), whereas those who received a transplant in a more advanced stage of disease were assigned to the poor-risk group (n = 36). In the related group (RCBT), 12 of 42 patients received transplantation from an HLA-disparate donor, whereas in the unrelated group (UCBT) 54 of 60 received an HLA mismatched CBT. Kaplan-Meier estimates for neutrophil recovery at day 60 were 84% ± 7% in RCBT and 79 ± 6% in UCBT (P = .16). In multivariate analysis, the most important factor influencing neutrophil engraftment in UCBT was a nucleated cell dose infused greater than 3.7 × 107/kg (P = .05, relative risk [RR] of 1.85, 95% confidence interval [CI]: 0.98-3.4). The incidence of grade II through IV acute graft-versus-host disease was 41% ± 8% in the RCBT group and 37% ± 6% in the UCBT group (P = .59). Kaplan-Meier estimates of 2-year event-free survival (EFS) after RCBT or UCBT were 39% ± 8% and 30% ± 7%, respectively (P = .19). In multivariate analysis, the most important factor influencing EFS was disease status at time of transplantation: good-risk patients had a 2-year EFS of 49% ± 7% as compared to 8% ± 5% in patients with more advanced disease (P = .0003, RR: 0.40, 95% CI: 0.24 to 0.65). This was a consequence of both an increased 1-year transplant related mortality and a higher 2-year relapse rate in the poor-risk group (65% ± 9% and 77% ± 14%, respectively), as compared with good risk patients (34% ± 6% and 31% ± 9%, respectively). These data confirm that allogeneic CBT from either a related or an unrelated donor is a feasible procedure able to cure a significant proportion of children with acute leukemia, especially if transplanted in a favorable phase of disease.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood.V93.11.3662