Outcome of relapse after allogeneic HSCT in children with ALL enrolled in the ALL-SCT 2003/2007 trial
Language English Country England, Great Britain Media print-electronic
Document type Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't
PubMed
29193007
DOI
10.1111/bjh.14965
Knihovny.cz E-resources
- Keywords
- children, leukaemia, relapse, stem cell transplantation,
- MeSH
- Precursor Cell Lymphoblastic Leukemia-Lymphoma diagnosis mortality therapy MeSH
- Survival Analysis MeSH
- Time Factors MeSH
- Child MeSH
- Transplantation, Homologous MeSH
- Remission Induction MeSH
- Infant MeSH
- Combined Modality Therapy MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Retreatment MeSH
- Child, Preschool MeSH
- Prognosis MeSH
- Proportional Hazards Models MeSH
- Recurrence MeSH
- Hematopoietic Stem Cell Transplantation adverse effects methods MeSH
- Treatment Outcome MeSH
- Salvage Therapy MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Research Support, Non-U.S. Gov't MeSH
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 of Paediatric Haematology and Oncology Teaching Hospital Motol Prague Czech Republic
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
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