TY - JOUR
T1 - Graft-versus-host disease in children who have received a cord blood or bone marrow transplant from an HLA-identical sibling
AU - Rocha, Vanderson
AU - Wagner, John E.
AU - Sobocinski, Kathleen A.
AU - Klein, John P.
AU - Zhang, Mei Jie
AU - Horowitz, Mary M.
AU - Gluckman, Eliane
PY - 2000/6/22
Y1 - 2000/6/22
N2 - Background: Umbilical-cord blood as an alternative to bone marrow for hematopoietic stem-cell transplantation may lower the risk of graft-versus- host disease (GVHD). Methods: We studied the records of 113 recipients of cord blood from HLA-identical siblings from the period from 1990 through 1997 and compared them with the records of 2052 recipients of bone marrow from HLA-identical siblings during the same period. The study population consisted of children 15 years of age or younger. We compared the rates of GVHD, hematopoietic recovery, and survival using Cox proportional-hazards regression to adjust for potentially confounding factors. Results: Recipients of cord blood were younger than recipients of bone marrow (median age, 5 years vs. 8 years; P<0.001), weighed less (median weight, 17 kg vs. 26 kg; P<0.001), and were less likely to have received methotrexate for prophylaxis against GVHD (28 percent vs. 65 percent, P<0.001). Multivariate analysis demonstrated a lower risk of acute GVHD (relative risk, 0.41; P=0.001) and chronic GVHD (relative risk, 0.35; P=0.02) among recipients of cord-blood transplants. As compared with recovery after bone marrow transplantation, the likelihood of recovery of the neutrophil count and the platelet count was significantly lower in the first month after cord-blood transplantation (relative risk, 0.40 [P<0.001], and relative risk, 0.20 [P<0.001], respectively). Mortality was similar in the two groups (relative risk of death in the recipients of cord blood, 1.15; P=0.43). Conclusions: Recipients of cord-blood transplants from HLA-identical siblings have a lower incidence of acute and chronic GVHD than recipients of bone marrow transplants from HLA-identical siblings. (C) 2000, Massachusetts Medical Society.
AB - Background: Umbilical-cord blood as an alternative to bone marrow for hematopoietic stem-cell transplantation may lower the risk of graft-versus- host disease (GVHD). Methods: We studied the records of 113 recipients of cord blood from HLA-identical siblings from the period from 1990 through 1997 and compared them with the records of 2052 recipients of bone marrow from HLA-identical siblings during the same period. The study population consisted of children 15 years of age or younger. We compared the rates of GVHD, hematopoietic recovery, and survival using Cox proportional-hazards regression to adjust for potentially confounding factors. Results: Recipients of cord blood were younger than recipients of bone marrow (median age, 5 years vs. 8 years; P<0.001), weighed less (median weight, 17 kg vs. 26 kg; P<0.001), and were less likely to have received methotrexate for prophylaxis against GVHD (28 percent vs. 65 percent, P<0.001). Multivariate analysis demonstrated a lower risk of acute GVHD (relative risk, 0.41; P=0.001) and chronic GVHD (relative risk, 0.35; P=0.02) among recipients of cord-blood transplants. As compared with recovery after bone marrow transplantation, the likelihood of recovery of the neutrophil count and the platelet count was significantly lower in the first month after cord-blood transplantation (relative risk, 0.40 [P<0.001], and relative risk, 0.20 [P<0.001], respectively). Mortality was similar in the two groups (relative risk of death in the recipients of cord blood, 1.15; P=0.43). Conclusions: Recipients of cord-blood transplants from HLA-identical siblings have a lower incidence of acute and chronic GVHD than recipients of bone marrow transplants from HLA-identical siblings. (C) 2000, Massachusetts Medical Society.
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U2 - 10.1056/NEJM200006223422501
DO - 10.1056/NEJM200006223422501
M3 - Article
C2 - 10861319
AN - SCOPUS:0034702284
SN - 0028-4793
VL - 342
SP - 1846
EP - 1854
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 25
ER -