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- Title
Hematopoietic cell transplantation in pediatric patients with acute leukemias or myelodysplastic syndrome using unrelated adult or umbilical cord blood donors in Brazil.
- Authors
Barbosa Tavares, Rita de Cássia; Sales Bonfim, Carmem; Seber, Adriana; Pereira Lermontov, Simone; Coulturato, Vergílio; Gottardello Zecchin, Victor; Ribeiro, Lisandro; Folloni Fernandes, Juliana; Esteves Daudt, Liane; Grecco, Carlos S.; Guilherme Darrigo-Jr, Luiz; Villela, Neysimélia; Nichele, Samantha; Gouveia, Roseane; Fernando Bouzas, Luís; Hamerschlak, Nelson; Celso Vigorito, Afonso; Moreira da Silva, Paula; de Oliveira da Silva, Priscila; Corrêa da Silva, Cinthya
- Abstract
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 × 107 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.
- Subjects
BRAZIL; HEMATOPOIETIC stem cell transplantation; CORD blood; MYELODYSPLASTIC syndromes; ACUTE leukemia; CHILD patients
- Publication
Pediatric Transplantation, 2020, Vol 24, Issue 7, p1
- ISSN
1397-3142
- Publication type
Article
- DOI
10.1111/petr.13789