期刊
JOURNAL OF CLINICAL ONCOLOGY
卷 33, 期 11, 页码 1265-+出版社
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.2014.58.9747
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资金
- Children's Cancer Research Institute, Vienna, Austria
- Deutsche Krebshilfe, Bonn, Germany
- Deutsche Knochenmarkspenderdatei, Tubingen, Germany
- Orphan Pharmaceuticals
- Amomed Pharma, Vienna, Austria
- Fresenius Biotech, Grafelfing, Germany
- Gilead Sciences, Vienna, Austria
- Medac, Wedel, Germany
Purpose Although hematopoietic stem-cell transplantation is widely performed in children with high-risk acute lymphoblastic leukemia (ALL), the influence of donor types is poorly understood. Thus, transplantation outcomes were compared in the prospective multinational Berlin-Frankfurt-Muenster (BFM) study group trial: ALL-SCT-BFM 2003 (Allogeneic Stem Cell Transplantation in Children and Adolescents with Acute Lymphoblastic Leukemia). Patients and Methods After conditioning with total-body irradiation and etoposide, 411 children with high-risk ALL received highly standardized stem-cell transplantations during the first or later remissions. Depending on donor availability, grafts originated from HLA-genoidentical siblings or from HLA-matched unrelated donors who were identified and matched by high-resolution allelic typing and were compatible in at least 9 of 10 HLA loci. Results Four-year event-free survival ( standard deviation [SD]) did not differ between patients with transplantations from unrelated or sibling donors (0.67 +/- 0.03 v 0.71 +/- 0.05; P = .405), with cumulative incidences of nonrelapse mortality (+/- SD) of 0.10 +/- 0.02 and 0.03 +/- 0.02 (P = .017) and relapse rates (+/- SD) of 0.22 +/- 0.02 and 0.24 +/- 0.04 (P = .732), respectively. Among recipients of transplantations from unrelated donors, no significant differences in event-free survival, overall survival, or nonrelapse mortality were observed between 9/10 and 10/10 matched grafts or between peripheral blood stem cells and bone marrow. The absence of chronic graft-versus-host disease had no effect on event-free survival. Engraftment was faster after bone marrow transplantation from siblings and was associated with fewer severe infections and pulmonary complications. Conclusion Outcome among high-risk pediatric patients with ALL after hematopoietic stem-cell transplantation was not affected by donor type. Standardized myeloablative conditioning produced a low incidence of treatment-related mortality and effective control of leukemia. (C) 2015 by American Society of Clinical Oncology
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