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 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.

Antalya Medicalpark Hospital Pediatric Stem Cell Transplantation Unit Antalya Turkey

Bone Marrow Transplantation Unit Comenius University Children's Hospital Bratislava Slovakia Bratislava Slovakia

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

Department of Pediatric and Adolescent Medicine Rigshospitalet Copenhagen University Hospital Copenhagen Denmark

Department of Pediatric Hematology and Oncology University Hospital Motol Prague Czech Republic

Department of Pediatric Hematology Oncology and BMT Wroclaw Medical University Wroclaw Poland

Department of Pediatric Oncology Hematology and Transplantology University of Medical Sciences Poznan Poland

Department of Pediatrics University Medical Centre Willem Alexander Children's Hospital Leiden The Netherlands

Hemato Immunology Department Robert Debre Hospital APHP and Paris Diderot University Paris France

Pediatric Hematology Oncology Schneider Children's Medical Center of Israel Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Princess Maxima Centre for Pediatric Oncology and Utrecht University Children's Hospital Utrecht The Netherlands

St Anna Children's Hospital UKKJ MUW Vienna Austria

References provided by Crossref.org

Total Body Irradiation or Chemotherapy Conditioning in Childhood ALL: A Multinational, Randomized, Noninferiority Phase III Study

The impact of donor type on the outcome of pediatric patients with very high risk acute lymphoblastic leukemia. A study of the ALL SCT 2003 BFM-SG and 2007-BFM-International SG

Myeloablative conditioning for allo-HSCT in pediatric ALL: FTBI or chemotherapy?-A multicenter EBMT-PDWP study

See more in PubMed

EudraCT
2005-005106-23

ClinicalTrials.gov
NCT01423500