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Unrelated bone marrow donor transplants for children with leukemia or
myelodysplasia
J Casper, B Camitta, R Truitt, LA Baxter-Lowe, N Bunin, C Lawton, K Murray, J Hunter, D Pietryga and F Garbrecht
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Allogeneic bone marrow transplantation is the treatment of choice for many
childhood leukemias. The donor of choice-an HLA matched sibling-is only
available about 30% of the time. Unrelated donors are an alternative
choice. In this report, we describe the results of unrelated donor bone
marrow transplants (BMT) in 50 children with leukemia (25 acute
lymphoblastic leukemia [ALL], 3 acute myeloid leukemia [AML], 3 juvenile
chronic myelogenous leukemia [JCML], 10 chronic myeloid leukemia [CML]) or
myelodysplastic syndrome (MDS; 9). The median age of the 31 male and 19
female patients was 9 years (range 2 to 18). Only 13 patients were
serologically matched at HLA-A, B, DR, and DQ with their donors; 6 of these
were reactive in mixed lymphocyte culture. The other 37 patients were
mismatched for one (36 patients) or more (1 patient) HLA antigens.
Pretransplant conditioning included cytosine arabinoside, cyclophosphamide,
fractionated total body irradiation (TBI) (with lung, liver, and more
recently, kidney shielding), and methylprednisolone. High-risk patients
also received busulfan. Graft-versus-host disease (GVHD) prophylaxis
consisted of T- cell depletion with IgM monoclonal antibody T10B9 plus
complement and posttransplant cyclosporine-A. Forty-nine patients (98%)
engrafted. Median times to greater than 500 polymorphonuclear leukocytes
(PMN)/microL and greater than 25,000 platelets/microL were 18 and 20 days,
respectively. Acute GVHD > or = grade II occurred in 16 patients (33%);
13 (81%) of these died. Chronic GVHD developed in 30 of 40 patients at
risk, but was extensive in only 5. Event-free survival (EFS) for all
patients was 44% +/- 7% (median follow-up was 49 months), and overall
survival was 50 +/- 7%. Patients with low-risk disease (ALL or AML in first
or second remission and CML in chronic phase) had a better EFS than
children with high-risk disease (60% v 34%, P = .07). There was no
significant difference in EFS between patients who were serologically
matched with their donors (46%) and those who were partially mismatched
(43%) (P = .97). These data compare favorably with published reports for
children transplanted with HLA-matched sibling donors and should encourage
earlier consideration of unrelated donor BMT in children with leukemia or
myelodysplasia.
Volume 85,
Issue 9,
pp. 2354-2363,
05/01/1995
Copyright © 1995 by The American Society of Hematology
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