TY - JOUR
T1 - GRFS and CRFS in alternative donor hematopoietic cell transplantation for pediatric patients with acute leukemia
AU - Mehta, Rohtesh S.
AU - Holtan, Shernan G.
AU - Wang, Tao
AU - Hemmer, Michael T.
AU - Spellman, Stephen R.
AU - Arora, Mukta
AU - Couriel, Daniel R.
AU - Alousi, Amin M.
AU - Pidala, Joseph
AU - Abdel-Azim, Hisham
AU - Ahmed, Ibrahim
AU - Aljurf, Mahmoud
AU - Askar, Medhat
AU - Auletta, Jeffery J.
AU - Bhatt, Vijaya
AU - Bredeson, Christopher
AU - Chhabra, Saurabh
AU - Gadalla, Shahinaz
AU - Gajewski, James
AU - Gale, Robert Peter
AU - Gergis, Usama
AU - Hematti, Peiman
AU - Hildebrandt, Gerhard C.
AU - Inamoto, Yoshihiro
AU - Kitko, Carrie
AU - Khandelwal, Pooja
AU - MacMillan, Margaret L.
AU - Majhail, Navneet
AU - Marks, David I.
AU - Mehta, Parinda
AU - Nishihori, Taiga
AU - Olsson, Richard F.
AU - Pawarode, Attaphol
AU - Diaz, Miguel Angel
AU - Prestidge, Tim
AU - Qayed, Muna
AU - Rangarajan, Hemalatha
AU - Ringden, Olle
AU - Saad, Ayman
AU - Savani, Bipin N.
AU - Seo, Sachiko
AU - Shah, Ami
AU - Shah, Niketa
AU - Schultz, Kirk R.
AU - Solh, Melhem
AU - Spitzer, Thomas
AU - Szer, Jeffrey
AU - Teshima, Takanori
AU - Verdonck, Leo F.
AU - Williams, Kirsten M.
AU - Wirk, Baldeep
AU - Wagner, John
AU - Yared, Jean A.
AU - Weisdorf, Daniel J.
N1 - Publisher Copyright:
© 2019 American Society of Hematology. All rights reserved.
PY - 2019
Y1 - 2019
N2 - We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors.
AB - We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors.
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UR - http://www.scopus.com/inward/citedby.url?scp=85068626630&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2018030171
DO - 10.1182/bloodadvances.2018030171
M3 - Article
C2 - 31053571
AN - SCOPUS:85068626630
SN - 2473-9529
VL - 3
SP - 1441
EP - 1449
JO - Blood advances
JF - Blood advances
IS - 9
ER -