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ORIGINAL ARTICLE
Korean J Pediatr 2012 March;55(3) :93-99.
doi:https://doi.org/10.3345/kjp.2012.55.3.93
Hematopoietic stem cell transplantation in children with acute leukemia: similar outcomes in recipients of umbilical cord blood versus marrow or peripheral blood stem cells from related or unrelated donors
Eun Sang Yi (Yi ES)1, Soo Hyun Lee (Lee SH)1, Meong Hi Son (Son MH)1, Ju Youn Kim (Kim JY)2, Eun Joo Cho (Cho EJ)2, Su Jin Lim (Lim SJ)3, Hee Won Cheuh (Cheuh HW)4, Keon Hee Yoo (Yoo KH)1, Ki Woong Sung (Sung KW)1, Hong Hoe Koo (Koo HH)1
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Children`s Cancer Center, Samsung Medical Center, Seoul, Korea
3Department of Nursing, Gangneung Youngdong College, Gangneung, Korea
4Department of Pediatrics, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
Corresponding Author: Hong Hoe Koo ,Tel: +82-2-3410-3524, Fax: +82-2-3410-0043, Email: hhkoo@skku.edu
Copyright © 2012 by The Korean Pediatric Society
ABSTRACT
Purpose : This study compared outcomes in children with acute leukemia who underwent transplantations with umbilical cord blood (UCB), bone marrow, or peripheral blood stem cells from a human leukocyte antigen (HLA)-matched related donor (MRD) or an unrelated donor (URD). Methods : This retrospective study included consecutive acute leukemia patients who underwent their first allogeneic hematopoietic stem cell transplantation (HSCT) at Samsung Medical Center between 2005 and 2010. Patients received stem cells from MRD (n=33), URD (n=46), or UCB (n=41). Results : Neutrophil and platelet recovery were significantly longer after HSCT with UCB than with MRD or URD (P<0.01 for both). In multivariate analysis using the MRD group as a reference, the URD group had a significantly higher risk of grade III to IV acute graft-versushost disease (GVHD; relative risk [RR], 15.2; 95% confidence interval [CI], 1.2 to 186.2; P=0.03) and extensive chronic GVHD (RR, 6.9; 95% CI, 1.9 to 25.2; P<0.01). For all 3 donor types, 5-year event-free survival (EFS) and overall survival were similar. Extensive chronic GVHD was associated with fewer relapses (RR, 0.1; 95% CI, 0.04 to 0.6; P<0.01). Multivariate analysis showed that lower EFS was associated with advanced disease at transplantation (RR, 3.2; 95% CI, 1.3 to 7.8; P<0.01) and total body irradiation (RR, 2.1; 95% CI, 1.0 to 4.3; P=0.04). Conclusion : Survival after UCB transplantation was similar to survival after MRD and URD transplantation. For patients lacking an HLA matched donor, the use of UCB is a suitable alternative.
Keywords: Umbilical cord blood | Hematopoietic stem cell transplantation | Stem cell donor
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