OUTCOME OF MYELOABLATIVE CONDTIONING AND UNRELATED DONOR HEMATOPOIETIC CELL TRANSPLANTATION FOR CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN THIRD REMISSION

• Published in: Biology of blood and marrow transplantation 2011-05, Vol.17 (12), p.1833-1840
• Main Authors: Nemecek, Eneida R., Ellis, Kristin, He, Wensheng, Bunin, Nancy J., Bajwa, Rajinder S., Cheerva, Alexandra, Cairo, Mitchell S., Dvorak, Christopher, Duval, Michel, Davies, Stella, Eapen, Mary, Gross, Thomas G., Hussein, Ayad A., MacMillan, Margaret L., Mehta, Parinda A., Pulsipher, Michael A., Seber, Adriana, Woolfrey, Ann E., Frangoul, Haydar A., Carpenter, Paul A.
• Format: Article
• Language: English
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2011.05.014

We conducted a retrospective study of 155 children who received unrelated donor hematopoietic cell transplantation (HCT) between 1990 and 2005 for acute lymphoblastic leukemia (ALL) in third remission. Median age of patients was 11 years, median time from diagnosis to first relapse was 36 months and median time from first to second relapse was 26 months. Stem cell sources were bone marrow (n=115), peripheral blood (n=11) or cord blood (n=29). All patients received a myeloablative transplant-conditioning regimen. The 5-year estimates of leukemia-free survival (LFS), relapse and non-relapse mortality were 30%, 25% and 45%, respectively. In multivariate analysis, the only risk factor associated with relapse was interval between first and second relapse. Second relapses that occurred late, >26 months from first relapse, were associated with lower risk for post-HCT relapse compared to second relapses ≤26 months (RR 0.4; p=0.01). Relapse risks were lowest when late second relapse was preceded by late first relapse (> 36 months from diagnosis) as shown by a 3-year relapse rate of 9%, p=0.0009. Long-term LFS can be achieved for children with ALL in third remission using unrelated donor HCT, especially when the second relapse occurred late.