Unrelated donor bone marrow transplantation for children with acute leukemia

S. M. Davies, J. E. Wagner, X. O. Shu, B. R. Blazar, Emmanuel Katsanis, P. J. Orchard, J. H. Kersey, K. E. Dusenbery, D. J. Weisdorf, P. B. McGlave, N. K. Ramsay

Research output: Contribution to journalArticle

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Abstract

Purpose: To test the use of unrelated donor bone marrow transplantation (URD BMT) to cure children with high-risk acute leukemias. Patients and Methods: Between June 1985 and December 1994, 50 children with acute leukemia (15 acute myelogenous leukemia [AML], 35 acute lymphoblastic leukemia [ALL]; 22 greater than second complete remission [CR]) received BMT from a URD at the University of Minnesota. Ages ranged from 0.9 to 17.5 years (median, 8.8). Median follow-up is 2.1 years (range, 1 to 7.3). Thirty patients (60%) received bone marrow fully matched at HLA-A,B and DRB1;20 (40%) received bone marrow with a major or minor mismatch at a single HLA-A or B locus. Results: The median time to neutrophil engraftment was day 24 (range, 14 to 42 days) in those receiving matched and day 25 (range, 15 to 32 days) in those receiving mismatched marrow (P = .35). The incidence of grades III to IV graft-versus-host disease (GVHD) was 23% (95% confidence interval [CI], 7% to 39%) in matched and 32% (95% CI, 8% to 52%) in HLA-mismatched patients (P = .57). The incidence of chronic GVHD was 50% (95% CI, 28% to 72%) in matched and 57% (95% CI, 23% to 91%) in mismatched patients (P = .80). Disease-free survival for patients with ALL is 37% (95% CI, 21% to 53%) at 1 year and 30% (95% CI, 15% to 46%) at 2 years; for patients with AML, 53% (95% CI, 28% to 78%) at 1 year and 33% (95% CI, 6% to 60%) at 2 years. Conclusion: URD BMT is an effective treatment for children with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended.

Original languageEnglish (US)
Pages (from-to)557-565
Number of pages9
JournalJournal of Clinical Oncology
Volume15
Issue number2
StatePublished - Feb 1997
Externally publishedYes

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Unrelated Donors
Bone Marrow Transplantation
Leukemia
Confidence Intervals
HLA-A Antigens
HLA-B Antigens
Bone Marrow
Graft vs Host Disease
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
HLA-DRB1 Chains
Incidence
Disease-Free Survival
Neutrophils
Referral and Consultation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Davies, S. M., Wagner, J. E., Shu, X. O., Blazar, B. R., Katsanis, E., Orchard, P. J., ... Ramsay, N. K. (1997). Unrelated donor bone marrow transplantation for children with acute leukemia. Journal of Clinical Oncology, 15(2), 557-565.

Unrelated donor bone marrow transplantation for children with acute leukemia. / Davies, S. M.; Wagner, J. E.; Shu, X. O.; Blazar, B. R.; Katsanis, Emmanuel; Orchard, P. J.; Kersey, J. H.; Dusenbery, K. E.; Weisdorf, D. J.; McGlave, P. B.; Ramsay, N. K.

In: Journal of Clinical Oncology, Vol. 15, No. 2, 02.1997, p. 557-565.

Research output: Contribution to journalArticle

Davies, SM, Wagner, JE, Shu, XO, Blazar, BR, Katsanis, E, Orchard, PJ, Kersey, JH, Dusenbery, KE, Weisdorf, DJ, McGlave, PB & Ramsay, NK 1997, 'Unrelated donor bone marrow transplantation for children with acute leukemia', Journal of Clinical Oncology, vol. 15, no. 2, pp. 557-565.
Davies SM, Wagner JE, Shu XO, Blazar BR, Katsanis E, Orchard PJ et al. Unrelated donor bone marrow transplantation for children with acute leukemia. Journal of Clinical Oncology. 1997 Feb;15(2):557-565.
Davies, S. M. ; Wagner, J. E. ; Shu, X. O. ; Blazar, B. R. ; Katsanis, Emmanuel ; Orchard, P. J. ; Kersey, J. H. ; Dusenbery, K. E. ; Weisdorf, D. J. ; McGlave, P. B. ; Ramsay, N. K. / Unrelated donor bone marrow transplantation for children with acute leukemia. In: Journal of Clinical Oncology. 1997 ; Vol. 15, No. 2. pp. 557-565.
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abstract = "Purpose: To test the use of unrelated donor bone marrow transplantation (URD BMT) to cure children with high-risk acute leukemias. Patients and Methods: Between June 1985 and December 1994, 50 children with acute leukemia (15 acute myelogenous leukemia [AML], 35 acute lymphoblastic leukemia [ALL]; 22 greater than second complete remission [CR]) received BMT from a URD at the University of Minnesota. Ages ranged from 0.9 to 17.5 years (median, 8.8). Median follow-up is 2.1 years (range, 1 to 7.3). Thirty patients (60{\%}) received bone marrow fully matched at HLA-A,B and DRB1;20 (40{\%}) received bone marrow with a major or minor mismatch at a single HLA-A or B locus. Results: The median time to neutrophil engraftment was day 24 (range, 14 to 42 days) in those receiving matched and day 25 (range, 15 to 32 days) in those receiving mismatched marrow (P = .35). The incidence of grades III to IV graft-versus-host disease (GVHD) was 23{\%} (95{\%} confidence interval [CI], 7{\%} to 39{\%}) in matched and 32{\%} (95{\%} CI, 8{\%} to 52{\%}) in HLA-mismatched patients (P = .57). The incidence of chronic GVHD was 50{\%} (95{\%} CI, 28{\%} to 72{\%}) in matched and 57{\%} (95{\%} CI, 23{\%} to 91{\%}) in mismatched patients (P = .80). Disease-free survival for patients with ALL is 37{\%} (95{\%} CI, 21{\%} to 53{\%}) at 1 year and 30{\%} (95{\%} CI, 15{\%} to 46{\%}) at 2 years; for patients with AML, 53{\%} (95{\%} CI, 28{\%} to 78{\%}) at 1 year and 33{\%} (95{\%} CI, 6{\%} to 60{\%}) at 2 years. Conclusion: URD BMT is an effective treatment for children with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended.",
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AU - Davies, S. M.

AU - Wagner, J. E.

AU - Shu, X. O.

AU - Blazar, B. R.

AU - Katsanis, Emmanuel

AU - Orchard, P. J.

AU - Kersey, J. H.

AU - Dusenbery, K. E.

AU - Weisdorf, D. J.

AU - McGlave, P. B.

AU - Ramsay, N. K.

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N2 - Purpose: To test the use of unrelated donor bone marrow transplantation (URD BMT) to cure children with high-risk acute leukemias. Patients and Methods: Between June 1985 and December 1994, 50 children with acute leukemia (15 acute myelogenous leukemia [AML], 35 acute lymphoblastic leukemia [ALL]; 22 greater than second complete remission [CR]) received BMT from a URD at the University of Minnesota. Ages ranged from 0.9 to 17.5 years (median, 8.8). Median follow-up is 2.1 years (range, 1 to 7.3). Thirty patients (60%) received bone marrow fully matched at HLA-A,B and DRB1;20 (40%) received bone marrow with a major or minor mismatch at a single HLA-A or B locus. Results: The median time to neutrophil engraftment was day 24 (range, 14 to 42 days) in those receiving matched and day 25 (range, 15 to 32 days) in those receiving mismatched marrow (P = .35). The incidence of grades III to IV graft-versus-host disease (GVHD) was 23% (95% confidence interval [CI], 7% to 39%) in matched and 32% (95% CI, 8% to 52%) in HLA-mismatched patients (P = .57). The incidence of chronic GVHD was 50% (95% CI, 28% to 72%) in matched and 57% (95% CI, 23% to 91%) in mismatched patients (P = .80). Disease-free survival for patients with ALL is 37% (95% CI, 21% to 53%) at 1 year and 30% (95% CI, 15% to 46%) at 2 years; for patients with AML, 53% (95% CI, 28% to 78%) at 1 year and 33% (95% CI, 6% to 60%) at 2 years. Conclusion: URD BMT is an effective treatment for children with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended.

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