Children with acute leukemia: a comparison of outcomes from allogeneic blood stem cell and bone marrow transplantation

Pediatr Blood Cancer. 2011 Jan;56(1):143-51. doi: 10.1002/pbc.22677.


Background: The relative merits of peripheral blood stem-cell transplantation (PBSCT) versus bone marrow transplantation (BMT) for children with standard and high-risk hematologic malignancies remain unclear. In a retrospective study, we compared allogeneic PBSCT (n = 30) with BMT (n = 110) in children with acute leukemia between January 2001 and September 2006.

Procedure: Median age for PBSCT was 9 years versus 8 years for BMT. Descriptive statistics were used to summarize the demographic and medical variables. The unadjusted probabilities of disease-free survival were estimated using the Kaplan-Meier method. The association of graft-source and time to each of the study endpoints was estimated by Cox's regression model and the occurrence of graft-versus-host disease (GvHD) was included as a time-dependent covariate.

Results: Time to neutrophil engraftment and platelet independence was faster after PBSCT than BMT (neutrophils 15.0 days vs. 17.0 days, P < 0.001; platelets, 21.0 days vs. 27.0 days, P = 0.034). The cumulative incidence of grades II-IV acute GvHD at 100 days was 10.4% (SE 5.6%) after PBSCT and 15.1% (SE 3.5%) after BMT (P = NS). The cumulative incidence of chronic GvHD was 13.8% (SE 6.3%) after PBSCT and 11.3% (SE 3.1%) after BMT (P = NS). One-year disease-free survival was 37.9% (SE 9.0%) for PBSCT recipients versus 65.1% (SE 4.6%) after BMT (P = 0.005) but this difference was not sustained in multivariate analysis. Thus, only disease risk and pre-transplant CMV seropositivity were significant predictors of disease-free survival.

Conclusions: We conclude that PBSCT for children produces faster engraftment without increased risk of acute or chronic GvHD.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Bone Marrow Transplantation / adverse effects
  • Bone Marrow Transplantation / methods*
  • Bone Marrow Transplantation / standards
  • Child
  • Child, Preschool
  • Female
  • Graft vs Host Disease
  • Hematopoiesis
  • Humans
  • Infant
  • Infant, Newborn
  • Kinetics
  • Leukemia / therapy*
  • Male
  • Peripheral Blood Stem Cell Transplantation / adverse effects
  • Peripheral Blood Stem Cell Transplantation / methods*
  • Peripheral Blood Stem Cell Transplantation / standards
  • Retrospective Studies
  • Transplantation, Homologous
  • Treatment Outcome