Twenty years of unrelated donor bone marrow transplantation for pediatric acute leukemia facilitated by the National Marrow Donor Program Journal Article
| Authors: | MacMillan, M. L.; Davies, S. M.; Nelson, G. O.; Chitphakdithai, P.; Confer, D. L.; King, R. J.; Kernan, N. A. |
| Article Title: | Twenty years of unrelated donor bone marrow transplantation for pediatric acute leukemia facilitated by the National Marrow Donor Program |
| Abstract: | The National Marrow Donor Program (NMDP) has facilitated unrelated donor hematopoietic cell transplants for more than 20 years. In this time period, there have been many changes in clinical practice, including improvements in HLA typing and supportive care, and changes in the source of stem cells. Availability of banked unrelated donor cord blood (incorporated into the NMDP registry in 2000) as a source of stem cells has become an important option for children with leukemia, offering the advantages of immediate availability for children with high-risk disease, the need for a lesser degree of HLA match, and expanding access for those with infrequent HLA haplotypes. Overall survival (OS) in children with acute leukemia transplanted with unrelated donor bone marrow (BM) is markedly better in more recent years, largely attributable to less treatment-related mortality (TRM). Within this cohort, 2-year survival was markedly better for patients with acute lymphoblastic leukemia (ALL) in first complete response (CR1) (74%) versus second complete response (CR2) (62%) or more advanced disease (33%). Similar findings are observed with patients with AML, suggesting earlier referral to bone marrow transplant (BMT) is optimal for survival. Notably, this improvement over time was not observed in unmodified peripheral blood stem cell (PBSC) recipients, suggesting unmodified PBSC may not be the optimal stem cell source for children. © 2008 American Society for Blood and Marrow Transplantation. |
| Keywords: | adolescent; cancer survival; child; controlled study; treatment outcome; survival rate; transplantation, homologous; acute granulocytic leukemia; major clinical study; overall survival; busulfan; advanced cancer; united states; clinical practice; medical decision making; etoposide; editorial; history, 21st century; cyclophosphamide; melphalan; hematopoietic stem cell transplantation; cancer mortality; acute lymphoblastic leukemia; high risk patient; stem cell; haplotype; health program; history, 20th century; cancer regression; acute leukemia; cord blood stem cell transplantation; hla matching; whole body radiation; hematologic neoplasms; registries; tissue donors; hla dr antigen; umbilical cord blood; graft rejection; hla a antigen; hla b antigen; hla c antigen; bone marrow transplantation; childhood leukemia; donor selection; hla typing; peripheral blood stem cell transplantation; hla antigen; patient referral; health care access; health care facility; unrelated donor; national marrow donor program; nmdp; national health programs; pediatric acute leukemia; health care availability |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 14 |
| Issue: | 9 SUPPL. |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-09-01 |
| Start Page: | 16 |
| End Page: | 22 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2008.05.019 |
| PUBMED: | 18721776 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 14" - "Export Date: 17 November 2011" - "CODEN: BBMTF" - "Source: Scopus" |
