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More chronic GvHD and non-relapse mortality after peripheral blood stem cell compared with bone marrow in hematopoietic transplantation for paediatric acute lymphoblastic leukemia: a retrospective study on behalf of the EBMT Paediatric Diseases Working Party

Bone Marrow Transplantation volume 52, pages 1071–1073 (2017)Cite this article

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Appropriate donor selection and stem-cell source are crucial issues of the allograft strategy. For many years and for historical reasons, bone marrow stem cells (BM) were the most common source used in the allograft setting. However, the use of peripheral blood stem cells (PB) became more frequent over the years.1, 2 In adults, many studies reported PB efficacy and safety regarding their use as an alternative to BM in hematopoietic stem-cell transplantation (HSCT).3, 4 Data regarding the association between HSCT outcome and stem-cell source from both pediatric donors and patients are limited,5 therefore, the role of PB as a stem-cell source is still debated in pediatrics. Allografts from PB, according to the Pediatric Blood and Marrow Transplant Consortium Experience (PBMTC) and the European Society for Blood and Marrow Transplantation (EBMT), are increasingly reported in children, with 30% in 2010 vs 10% few years earlier.6, 7 In pediatric patients, only one large study published in 2004 by Eapen et al.5 specifically addressed the question of clinical outcomes after either BM or PB HSCT from HLA-identical sibling donors in children with ALL. This study reported a higher risk of chronic GvHD in the PB group with no positive impact on relapse rate and survival. Therefore, we conducted a retrospective analysis comparing HSCT outcomes after either BM or PB allografts in children, and adolescents below 18 years transplanted for ALL in first or subsequent CR among EBMT centers. We excluded patients with ALL transplanted from cord blood or ex vivo T cell-depleted transplants, and patients who received second or subsequent HSCT.

We report here the EBMT experience demonstrating the inferiority of PB HSCT for children with ALL, due to higher incidence of cGvHD and higher risk of NRM without improvement of relapse risk. A faster neutrophil engraftment was the only benefit of PB vs BM graft that could be identified. In adults, several studies provided consistent and relevant data concerning efficacy and safety of PB as an alternative hematopoietic stem-cell source for HSCT. Some clinical trials in adults comparing PB vs BM have reported a survival benefit in some population, in particular a decreased risk of disease relapse. In a meta-analysis published by the Stem Cell Trialists Collaborative Group in 2005, PB grafts were associated with a decreased risk of relapse (21% vs 27% at 3 years; P=0.01). However, PB appeared also as a risk factor for GvHD (68% vs 52% at 3 years; P<0.001).9 In 2012, a phase-III multicenter randomized trial comparing PB vs BM transplantation from unrelated donors found an incidence of chronic GvHD at 2 years in the PB group of 53% compared with 41% in the bone marrow group (P=0.01).4 Causes of the higher risk of cGvHD are still debated. For some authors the higher T-cell numbers in mobilized PB10, 11 may have a relevant role, for others, the donor sensitivity to granulocyte-colony stimulating factor (G-CSF) and his/her ability to mobilize stem cells is associated with the risk of cGvHD, regardless of CD3+ T cell or CD34+ cell number.12 On the basis of these adult studies, despite the lack of pediatric data, some pediatricians may decide to use PB in pediatric HSCT. But the choice of the allograft source is mainly up to the donor center or the donor himself, at least in the unrelated setting.

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Authors and Affiliations

  1. Department of Pediatric Clinical Hematology, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (APHP), University Paris Diderot, Paris, France

    M Simonin & J-H Dalle

  2. Department of Biostastistics, Hôpital Saint-Antoine, Paris, France

    A Dalissier & M Labopin

  3. Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany

    A Willasch & P Bader

  4. Department of Pediatric Hematology,

    M Zecca

  5. San Mateo, Pavia, Italy

    M Zecca

  6. Department of Pediatric Hematology, King Faisal, Riyadh, Saudi Arabia

    A Mouhab

  7. Department of Pediatric Hematology, Wrocław Medical University, Wrocław, Poland

    A Chybicka

  8. Department of Pediatric Hematology, Clinica Pediatrica Università degli Studi di Milano Bicocca, Monza, Italy

    A Balduzzi

  9. Department of Pediatric Hematology, Helsinki University Central Hospital, Helsinki, Finland

    L Volin

  10. Department of Pediatric Hematology, St Anna Children's Hospital, Vienna, Austria

    C Peters

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Simonin, M., Dalissier, A., Labopin, M. et al. More chronic GvHD and non-relapse mortality after peripheral blood stem cell compared with bone marrow in hematopoietic transplantation for paediatric acute lymphoblastic leukemia: a retrospective study on behalf of the EBMT Paediatric Diseases Working Party. Bone Marrow Transplant 52, 1071–1073 (2017). https://doi.org/10.1038/bmt.2017.66

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