Second Hematopoietic Stem Cell Transplantation for Post-Transplantation Relapsed Acute Leukemia in Children: A Retrospective EBMT-PDWP Study

• Published in: Biology of blood and marrow transplantation 2018-08, Vol.24 (8), p.1629-1642
• Main Authors: Yaniv, Isaac, Krauss, Aviva C., Beohou, Eric, Dalissier, Arnaud, Corbacioglu, Selim, Zecca, Marco, Afanasyev, Boris V., Berger, Massimo, Diaz, Miguel Angel, Kalwak, Krzysztof, Sedlacek, Petr, Varotto, Stefania, Peters, Christina, Bader, Peter
• Format: Article
• Language: English
• Subjects: Adolescent; cGVHD; Child; Child, Preschool; Female; Graft vs Host Disease - mortality; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic Stem Cell Transplantation - mortality; Humans; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prognosis; Recurrence; Relapse pediatric acute leukemia; Reoperation; Retrospective Studies; Second HSCT; Survival Analysis
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2018.03.002

Outcome data were collected from the European Society for Blood and Marrow Transplantation registry on 373 children from 120 centers with relapsed leukemia (214 with acute lymphoblastic leukemia [ALL] and 159 with acute myelogenous leukemia [AML]) who underwent second allogeneic hematopoietic stem cell transplantation (HSCT) between 2004 and 2013. Overall survival (OS) was 38% at 2 years and 29% at 5 years, and leukemia-free survival (LFS) was 30% at 2 years and 25% at 5 years. Median follow-up after second HSCT was 36.4 months in the ALL group and 50.2 months in the AML group. In the ALL group, OS was 43% at 2 years and 33% at 5 years, and LFS was 34% at 2 years and 31% at 5 years. In the AML group, OS was 32% at 2 years and 24% at 5 years, and LFS was 24% at 2 years and 17% at 5 years. The 2-year nonrelapse mortality (NRM) rate was 22% in the ALL group and 18% in the AML group. Favorable prognostic factors (P 12 months between transplantations and chronic graft-versus-host disease after the first HSCT (in both groups), complete response before the second HSCT (ALL group only), and age >12 years (AML group only). Findings were more consistent over time in the ALL group, with no significant differences between 2-year and 5-year rates of relapse, NRM, and LFS. Children with relapsed acute leukemias have a substantial likelihood of long-term survival following second HSCT. Given the many novel targeted and immunomodulation therapies currently under development, it is important to identify specific patient subpopulations that may benefit from a second HSCT compared with those better suited to new approaches.