J Korean Med Sci.  2009 Oct;24(5):904-909. 10.3346/jkms.2009.24.5.904.

Unrelated Hematopoietic Stem Cell Transplantation for Children with Acute Leukemia: Experience at a Single Institution

• Lee JH
• Yoon HS
• Song JS
• Choi ES
• Moon HN
• Seo JJ
• Im HJ

• KMID: 1782014
• DOI: http://doi.org/10.3346/jkms.2009.24.5.904

Abstract

We evaluate the outcomes in children with acute leukemia who received allogeneic hematopoietic stem cell transplantation (HCT) using unrelated donor. Fifty-six children in complete remission (CR) received HCT from unrelated donors between 2000 and 2007. Thirty-five had acute myeloid leukemia, and 21 had acute lymphoid leukemia. Stem cell sources included bone marrow in 38, peripheral blood in 4, and cord blood (CB) in 14. Four patients died before engraftment and 52 engrafted. Twenty patients developed grade II-IV acute graft-versus-host disease (GVHD) and 8 developed extensive chronic GVHD. With median follow-up of 39.1 months, event free survival and overall survival were 60.4% and 67.5%, respectively, at 5 yr. Events included relapse in 10 and treatment-related mortality (TRM) in 10. The causes of TRM included sepsis in 4, GVHD in 4 (1 acute GVHD and 3 chronic GVHD), veno-occlusive disease in 1 and fulminant hepatitis in 1. Patients transplanted with CB had event free survival of 57.1%, comparable to 63.2% for those transplanted with other than CB. In conclusion, HCT with unrelated donors is effective treatment modality for children with acute leukemia. In children with acute leukemia candidate for HCT but lack suitable sibling donor, unrelated HCT may be a possible treatment option at the adequate time of their disease.

Keyword

Child; Acute Leukemia; Allogeneic Hematopoietic Stem Cell Transplantation; Unrelated Donor

MeSH Terms

Adolescent
Bone Marrow Transplantation
Child
Child, Preschool
Cord Blood Stem Cell Transplantation
Disease-Free Survival
Female
Graft vs Host Disease/etiology/immunology
*Hematopoietic Stem Cell Transplantation
Humans
Infant
Leukemia, Myeloid, Acute/complications/mortality/*therapy
Male
Peripheral Blood Stem Cell Transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/mortality/*therapy
Risk Factors
Time Factors
Transplantation, Homologous

Figure

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  Fig. 1 Engraftment rate of neutrophils (A) and platelets (B) according to stem cell sources.

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  Fig. 2 Probability of 5 yr event free survival (EFS) (A) and overall survial (OS) (B) according to disease.

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