Higher Mortality After Allogeneic Peripheral-Blood Transplantation Compared With Bone Marrow in Children and Adolescents: The Histocompatibility and Alternate Stem Cell Source Working Committee of the International Bone Marrow Transplant Registry
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Discussion
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Implication
Observational cohort study shows higher mortality after peripheral-blood stem cell transplantation than bone marrow in pediatric leukemia, highlighting potential risks of changing practice.
Key Points
- To compare clinical outcomes and mortality between allogeneic peripheral-blood stem cell (PBSC) and bone marrow (BM) transplantation from HLA-identical sibling donors in children and adolescents with acute leukemia.
- Retrospective registry-based cohort study comparing 143 PBSC and 630 BM transplant recipients aged 8 to 20 years with acute leukemia.
- Multivariable Cox proportional hazards regression was used to adjust for confounding differences such as patient age, disease stage, post-transplant growth factor use, and transplantation era.
- PBSC transplantation was associated with a higher risk of chronic graft-versus-host disease compared to BM transplantation (RR, 1.85; 95% CI, 1.28 to 2.66; P = .001), while grade 2 to 4 acute GVHD and relapse risks did not significantly differ.
- PBSC recipients exhibited significantly higher treatment-related mortality (RR, 1.89; 95% CI, 1.28 to 2.80; P = .001), treatment failure (RR, 1.31; 95% CI, 1.03 to 1.68; P = .03), and overall mortality (RR, 1.38; 95% CI, 1.07 to 1.79; P = .01) compared with BM recipients.
Cite This Study
Eapen et al. (2004) studied this question.