Rohtesh S. Mehta, The University of Texas MD Anderson Cancer Center
Shernan G Holtan, University of Minnesota
Tao Wang, Medical College of Wisconsin
Michael T. Hemmer, Medical College of Wisconsin
Stephen R. Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis
Mukta Arora, University of Minnesota Medical Center
Daniel R. Couriel, Utah Blood and Marrow Transplant Program
Amin M. Alousi, The University of Texas MD Anderson Cancer Center
Joseph Pidala, H. Lee Moffitt Cancer Center
Hisham Abdel-Azim, Children's Hospital Los Angeles, University of Southern California
Ibrahim Ahmed, Children's Mercy Hospitals and Clinics
Mahmoud Aljurf, King Faisal Specialist Hospital and Research Centre
Medhat Askar, Baylor University Medical Center
Jeffery J. Auletta, Nationwide Children's Hospital
Vijaya Bhatt, Nebraska Medical Center
Christopher Bredeson, Ottawa Hospital Research Institute
Saurabh Chhabra, Medical College of Wisconsin
Shahinaz Gadalla, National Institutes of Health
James Gajewski, Oregon Health and Science University
Robert Peter Gale, Imperial College London
Usama Gergis, New York Presbyterian Hospital, Weill Cornell Medical Center
Peiman Hematti, University of Wisconsin Hospital and Clinics
Gerhard C. Hildebrandt, University of Kentucky
Yoshihiro Inamoto, National Cancer Center Hospital, Tokyo
Carrie Kitko, Vanderbilt University Medical Center
Pooja Khandelwal, Cincinnati Children's Hospital Medical Center
Margaret L. MacMillan, University of Minnesota Blood and Marrow Transplant Program
Navneet Majhail, Cleveland Clinic Taussig Cancer Institute
David I. Marks, University Hospitals Bristol NHS Trust
Parinda Mehta, Cincinnati Children's Hospital Medical Center
Taiga Nishihori, H. Lee Moffitt Cancer Center
Richard F. Olsson, Karolinska Institutet; Uppsala University
Attaphol Pawarode, University of Michigan Medical School
Miguel Angel Diaz, Hospital Infantil Universitario Nino Jesus
Tim Prestidge, Starship Children's Hospital, Auckland
Muna Qayed, Emory University School of Medicine
Hemalatha Rangarajan, Nationwide Children's Hospital, Columbus
Olle Ringden, Karolinska Institutet
Ayman Saad, University of Alabama at Birmingham
Bipin N. Savani, Vanderbilt University Medical Center
Sachiko Seo, National Cancer Research Center East, Chiba
Ami Shah, Stanford School of Medicine
Niketa Shah, Yale New Haven Hospital
Kirk R. Schultz, University of British Columbia
Melhem Solh, Northside Hospital, Atlanta
Thomas Spitzer, Massachusetts General Hospital
Jeffrey Szer, Royal Melbourne Hospital
Takanori Teshima, Kyushu University Hospital
Leo F Verdonck, Isala Clinic, Zwolle
Kirsten M. Williams, Children's National Health Systems
Baldeep Wirk, Seattle Cancer Care Alliance
John Wagner, Thomas Jefferson UniversityFollow
Jean A. Yared, University of Maryland
Daniel J. Weisdorf, University of Minnesota

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Publication Date



This article has been peer reviewed. It is the author’s final published version in Blood Advances, Volume 3, Issue 9, May 2019, Pages 1441-1449.

The published version is available at Copyright © American Society of Hematology


We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors. © 2019 American Society of Hematology. All rights reserved.

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