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Recent decrease in acute graft-versus-host disease in children with leukemia receiving unrelated donor bone marrow

Stella M Davies¹, Dan Wang, Tao Wang

¹Dept. of Pediatrics, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.

Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation

|February 11, 2009

Summary

Unrelated donor bone marrow transplants for childhood leukemia show evolving outcomes. Recent transplantations have a reduced risk of acute graft-versus-host disease (aGVHD), improving treatment success.

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Published on: March 14, 2011

Area of Science:

Pediatric Hematology/Oncology
Transplantation Immunology
Clinical Outcomes Research

Background:

Unrelated donor bone marrow transplantation (URD BMT) is a vital leukemia treatment for children.
Graft-versus-host disease (GVHD) and relapse remain significant challenges impacting URD BMT success rates.
Understanding GVHD incidence and risk factors is crucial for optimizing pediatric BMT protocols.

Purpose of the Study:

To investigate the incidence and risk factors of acute graft-versus-host disease (aGVHD) over time in pediatric patients undergoing unrelated donor bone marrow transplantation (URD BMT).
To analyze the impact of aGVHD on relapse rates in children with different types of leukemia.
To identify trends in aGVHD risk associated with changes in transplantation practices.

Main Methods:

Analysis of 638 myeloablative URD BMT cases performed between 1990-2003 for pediatric leukemia and myelodysplastic syndrome.
Utilized the Center for International Blood and Marrow Transplant Research (CIBMTR) database with high-resolution HLA typing.
Statistical analysis including odds ratios (OR) and confidence intervals (CI) to assess GVHD incidence and risk factors.

Main Results:

27% of pediatric URD BMT recipients developed grade III-IV acute GVHD (aGVHD).
T cell-depleted grafts significantly reduced aGVHD risk compared to T cell-replete grafts (OR=3.12).
aGVHD lowered relapse risk in acute lymphoblastic leukemia (ALL) but not acute myelogenous leukemia (AML).
The risk of aGVHD was significantly higher in earlier transplantations (1990-1998) versus later ones (1999-2003) (OR=1.93).

Conclusions:

Pediatric URD BMT outcomes have improved over time, with a notable decrease in aGVHD risk in recent years.
Graft manipulation strategies, such as T cell depletion, are effective in mitigating aGVHD.
The relationship between aGVHD and relapse varies by leukemia subtype, highlighting the complexity of the graft-versus-leukemia effect.