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Hematopoietic cell transplantation in pediatric patients with acute leukemias or myelodysplastic syndrome using unrelated adult or umbilical cord blood donors in Brazil
Author(s) -
Tavares Rita de Cássia Barbosa,
Bonfim Carmem Sales,
Seber Adriana,
Pereira Lermontov Simone,
Coulturato Vergílio,
Zecchin Victor Gottardello,
Ribeiro Lisandro,
Fernandes Juliana Folloni,
Daudt Liane Esteves,
Grecco Carlos S.,
DarrigoJr Luiz Guilherme,
Villela Neysimélia,
Nichele Samantha,
Gouveia Roseane,
Bouzas Luís Fernando,
Hamerschlak Nelson,
Vigorito Afonso Celso,
Silva Paula Moreira,
Silva Priscila de Oliveira,
Silva Cinthya Corrêa,
Souza Fernandez Cecília,
Flowers Mary Evelyn,
Arcuri Leonardo Javier
Publication year - 2020
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13789
Subject(s) - medicine , umbilical cord , gastroenterology , transplantation , cord blood , acute leukemia , bone marrow , leukemia , hematopoietic cell , cumulative incidence , surgery , immunology , haematopoiesis , stem cell , biology , genetics
The choice of alternative donors for HCT for patients without an HLA‐matched related donor depends on several factors. We compared major HCT outcomes in 212 consecutive children transplanted at 11 centers in Brazil for acute leukemia or MDS from an HLA‐matched unrelated donor (MUD, n = 95), mismatched unrelated donor (MMUD, n = 47) or unrelated umbilical cord blood (UCB, n = 70). Most had ALL (61%), bone marrow (57%) as the graft source and 95% received a MAC regimen. The 3‐year OS probability were 57, 55, and 37% after HCT from MUD, MMUD, and UCB, respectively (HR 1.68, 95%CI 1.07‐2.63; P = .02). In comparison with MUD, OS was similar after transplantation of a ≥ 6/8 HLA‐matched or a high cell dose (>5 × 10 7 TNC/kg) CB unit (HR 1.41, 95%CI 0.88‐2.27; P = .15). NRM was higher for UCB (HR 3.90, 95%CI 1.43‐10.7; P = .01) but not for MMUD (HR 1.03, 95%CI 0.53‐2.00; P > .20). Advanced disease (HR 2.05, 95%CI 1.26‐3.33; P < .001) and UCB with high probability of being < 6/8 HLA‐matched (HR 5.34, 95%CI 2.0‐13.9; P < .001) were associated with higher mortality. Relapse and acute GVHD were similar among groups, while PGF was higher among UCB transplants ( P = .002) and chronic GVHD among MMUD group (HR 2.88, 95% CI 1.05‐7.88; P = .04). Our results suggest that in Brazil HCT outcomes performed with MMUD and MUD donors were comparable, while with UCB units < 6/8 HLA‐matched were associated with higher NRM for children with acute leukemia or MDS.