Unrelated donor marrow transplantation in children

Abstract

Eighty-eight children 0.5 to 17 years of age (median, 9 years of age) received an unrelated donor marrow transplant for treatment of chronic myeloid leukemia (CML; n = 16), acute lymphoblastic leukemia (ALL) in first or second remission (n = 15) or more advanced stage (n = 28), acute myeloid leukemia (AML; n = 13), or other hematologic diseases (n = 16) between June 1985 and April 1993. All patients were conditioned with cyclophosphamide and total body irradiation and received a combination of methotrexate and cyclosporine as graft-versus-host disease (GVHD) prophylaxis. Fourty-six patients received transplants from HLA-identical donors and 42 patients received transplants from donors who were minor-mismatched at one HLA-A or B or D/DRB1 locus. The Kaplan-Meier estimates of disease-free survival and relapse were 75% and 0% for patients with CML, 47% and 20% for ALL in first or second remission, 10% and 60% for ALL in relapse or third remission, 46% and 46% for AML in first remission (n = 1) or more advanced disease (n = 12), and 29% and 69% for other diseases. HLA disparity was not significantly associated with lower disease-free survival, but the results suggest more relapses in HLA-matched recipients and there was significantly more transplant-related mortality in mismatched recipients (51% v 24%, P = .04). Most deaths were due to infections associated with acuteor chronic GVHD and occurred within the first 2 years after transplantation. Granulocyte engraftment occurred in all evaluable patients. Sixty-three percent of HLA-matched and 57% of HLA-mismatched recipients were discharged home disease-free at a median of 98 and 103 days, respectively, after transplantation (P = not significant [NS]). The incidence of grades II-IV acute GVHD was 83% in HLA-matched and 98% in HLA-mismatched recipients (P = .009). The incidence of chronic GVHD was 60% in HLA-matched and 69% in HLA- mismatched recipients (P = NS). One or multiple late adverse events such as cataracts, osteonecrosis of the hip or knee, restrictive or obstructive pulmonary disease, and hypothyroidism have occurred in 11 of 33 (33%) surviving patients. Immunosuppression was discontinued in 58% of surviving patients, including all 12 patients surviving more than 3.2 years, all of whom have a Lansky or Karnofsky score of 100%.(ABSTRACT TRUNCATED AT 400 WORDS)

The UK experience in treating relapsed childhood acute lymphoblastic leukaemia: a report on the Medical Research Council UKALLR1 study

“…There are very limited available data on the ef®cacy of alternative donors in childhood-relapsed ALL. However, 2-year EFS rates similar to those of sibling transplants of 40±56% have been reported (Kernan et al, 1993;Balduzzi et al, 1995;Casper et al, 1995;Davies et al, 1995;Oakhill et al, 1996).…”

Osteonecrosis in Children After Therapy for Malignancy

“…In patients who have undergone allogeneic bone marrow transplantation, the reported incidence of osteonecrosis of any joint ranges from 3.9% to 44.2% [21][22][23][24]. Recently, nearly 22% of prospectively monitored pediatric patients, irrespective of clinical symptoms, were found to have MR-documented osteonecrosis of the hips or knees.…”

Non‐endocrine late complications of bone marrow transplantation in childhood: part II

“…Non-traumatic avascular necrosis of bone (AVN) after BMT was first brought to attention by Atkinson et al (1987). Although less common than in adults, it has subsequently been reported in children (Mascarin et al, 1991;Fletcher et al, 1994;Balduzzi et al, 1995;Gordon et al, 1997;Pitcher et al, 1998;Matthes-Martin et al, 1999).…”