Reduction in Mortality after Umbilical Cord Blood Transplantation in Children Over a 20-Year Period (1995-2014).

Spees, Lisa P

Martin, Paul L

Kurtzberg, Joanne

Stokhuyzen, Andre

McGill, Lauren

Prasad, Vinod K

Driscoll, Timothy A

Parikh, Suhag H

Page, Kristin M

Vinesett, Richard

Severyn, Christopher

Sung, Anthony D

Proia, Alan D

Jenkins, Kirsten

Arshad, Mehreen

Steinbach, William J

Seed, Patrick C

Kelly, Matthew S

2022-03-23T15:35:31Z

2022-03-23T15:35:31Z

2019-04

2022-03-23T15:35:30Z

Infections and graft-versus-host disease (GVHD) have historically resulted in high mortality among children undergoing umbilical cord blood transplantation (UCBT). However, recent advances in clinical practice have likely improved outcomes of these patients. We conducted a retrospective cohort study of children (<18years of age) undergoing UCBT at Duke University between January 1, 1995 and December 31, 2014. We compared 2-year all-cause and cause-specific mortality during 3 time periods based on year of transplantation (1995 to 2001, 2002 to 2007, and 2008 to 2014). We used multivariable Cox regression to identify demographic and UCBT characteristics that were associated with all-cause mortality, transplantation-related mortality, and death from invasive aspergillosis after adjustment for time period. During the 20-year study period 824 children underwent UCBT. Two-year all-cause mortality declined from 48% in 1995 to 2001 to 30% in 2008 to 2014 (P = .0002). White race and nonmalignant UCBT indications were associated with lower mortality. Black children tended to have a higher risk of death for which GVHD (18% versus 11%; P = .06) or graft failure (9% versus 3%; P = .01) were contributory than white children. Comparing 2008 to 2014 with 1995 to 2001, more than half (59%) of the reduced mortality was attributable to a reduction in infectious mortality, with 45% specifically related to reduced mortality from invasive aspergillosis. Antifungal prophylaxis with voriconazole was associated with lower mortality from invasive aspergillosis than low-dose amphotericin B lipid complex (hazard ratio, .09; 95% confidence interval, .01 to .76). With the decline in mortality from invasive aspergillosis, adenovirus and cytomegalovirus have become the most frequentinfectious causes of death in children after UCBT. Advances in clinical practice over the past 20years improved survival of children after UCBT. Reduced mortality from infections, particularly invasive aspergillosis, accounted for the largest improvement in survival and was associated with use of voriconazole for antifungal prophylaxis.

S1083-8791(18)30751-1

1083-8791

1523-6536

https://hdl.handle.net/10161/24602

eng

Elsevier BV

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

10.1016/j.bbmt.2018.11.018

Humans

Cord Blood Stem Cell Transplantation

Survival Rate

Retrospective Studies

Cohort Studies

Time Factors

History, 20th Century

History, 21st Century

Female

Male

Reduction in Mortality after Umbilical Cord Blood Transplantation in Children Over a 20-Year Period (1995-2014).

Journal article

Martin, Paul L|0000-0001-8141-5678

Kurtzberg, Joanne|0000-0002-3370-0703

Parikh, Suhag H|0000-0002-6066-9852

Page, Kristin M|0000-0001-9670-8828

Sung, Anthony D|0000-0003-3765-641X

Proia, Alan D|0000-0001-6646-2695

Kelly, Matthew S|0000-0001-8819-2315

756

763

4

Duke

School of Medicine

Faculty

Basic Science Departments

Clinical Science Departments

Institutes and Centers

Molecular Genetics and Microbiology

Ophthalmology

Pathology

Pediatrics

Surgery

Pediatrics, Infectious Diseases

Surgery, Urology

Duke Cancer Institute

Institutes and Provost's Academic Units

University Institutes and Centers

Duke Global Health Institute

Center for the Study of Aging and Human Development

Initiatives

Duke Innovation & Entrepreneurship

Pediatrics, Transplant and Cellular Therapy

Published

25