Relapse remains the major cause of treatment failure in children with high-risk acute lymphoblastic leukaemia (ALL) undergoing allogeneic haematopoietic stem-cell transplantation (allo-SCT). Prognosis is considered dismal but data on risk factors and outcome are lacking from prospective studies. We analysed 242 children with recurrence of ALL after first allo-SCT enrolled in the Berlin-Frankfurt-Munster (BFM) ALL-SCT-BFM 2003 and ALL-SCT-BFM international 2007 studies. Median time from allo-SCT to relapse was 7·7 months; median follow-up from relapse after allo-SCT until last follow-up was 3·4 years. The 3-year event-free survival (EFS) was 15% and overall survival (OS) was 20%. The main cause of death was disease progression or relapse (86·5%). The majority of children (48%) received salvage therapy without second allo-SCT, 26% of the children underwent a second allo-SCT and 25% received palliative treatment only. In multivariate analyses, age, site of relapse, time to relapse and type of salvage therapy were identified as significant prognostic factors for OS and EFS, whereas factors associated with first SCT were not statistically significant. Combined approaches incorporating novel immunotherapeutic treatment options and second allo-SCT hold promise to improve outcome in children with post allo-SCT relapse.

Bone Marrow Transplant Unit Schneider Children's Medical Centre of Israel Petach Tikva Israel

Clinica Pediatrica Università degli Studi di Milano Bicocca Ospedale San Gerardo Monza Italy

Comprehensive Cancer Centre Munich Munich Germany

Department for Children and Adolescents Division for Stem Cell Transplantation and Immunology University Hospital Frankfurt Goethe University Frankfurt Germany

Department for Children and Adolescents Rigahospitalet Copenhagen University Hospital Copenhagen Denmark

Department of Paediatric Haematology and Oncology Haematopoietic Stem Cell Transplantation Unit Comenius University Children's Hospital Bratislava Bratislava Slovakia

Department of Paediatric Haematology and Oncology Teaching Hospital Motol Prague Czech Republic

Department of Paediatric Oncology Haematology and Clinical Immunology Medical Faculty University Children's Hospital Heinrich Heine University Duesseldorf Germany

Department of Paediatric Oncology Haematology Charité Universitätsmedizin Berlin Charité Campus Virchow Berlin Germany

Department of Paediatrics and Adolescent Medicine Division of Paediatric Haematology and Oncology Medical Centre Faculty of Medicine University of Freiburg Freiburg Germany

Department of Paediatrics Klinikum rechts der Isar Technische Universität München Munich Germany

Department of Paediatrics University Medical Centre Schleswig Holstein Kiel Germany

Division of Stem Cell Transplantation University Children's Hospital Zürich Zürich Switzerland

Ezer Mizion Bone Marrow Donor Registry Petach Tikva Israel

Paediatric Haematology Department Robert Debré Hospital and Paris Diderot University Paris France

St Anna Children's Hospital Vienna Austria

University Hospital Tuebingen Tuebingen Germany

University of Medical Sciences Poznan Poland

Citace poskytuje Crossref.org