Korean J Pediatr.  2012 Mar;55(3):100-106. 10.3345/kjp.2012.55.3.100.

Outcome of allogeneic hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia in second complete remission: a single institution study

• Lee EJ
• Han JY
• Lee JW
• Jang PS
• Chung NG
• Jeong DC
• Cho B
• Kim HK

• KMID: 2284316
• DOI: http://doi.org/10.3345/kjp.2012.55.3.100

Abstract

PURPOSE
The survival rate for childhood acute lymphoblastic leukemia (ALL) has improved significantly. However, overall prognosis for the 20 to 25% of patients who relapse is poor, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the best chance for cure. In this study, we identified significant prognostic variables by analyzing the outcomes of allogeneic HSCT in ALL patients in second complete remission (CR).
METHODS
Fifty-three ALL patients (42 men, 79%) who received HSCT in second CR from August 1991 to February 2009 were included (26 sibling donor HSCTs, 49%; 42 bone marrow transplantations, 79%). Study endpoints included cumulative incidence of acute and chronic graft-versus-host disease (GVHD), relapse, 1-year transplant-related mortality (TRM), disease-free survival (DFS), and overall survival (OS).
RESULTS
Cumulative incidences of acute GVHD (grade 2 or above) and chronic GVHD were 45.3% and 28.5%, respectively. The estimated 5-year DFS and OS for the cohort was 45.2+/-6.8% and 48.3+/-7%, respectively. Only donor type, i.e., sibling versus unrelated, showed significant correlation with DFS in multivariate analysis (P=0.010). The rates of relapse and 1 year TRM were 28.9+/-6.4% and 26.4+/-6.1%, respectively, and unrelated donor HSCT (P=0.002) and HLA mismatch (P=0.022) were significantly correlated with increased TRM in univariate analysis.
CONCLUSION
In this single institution study spanning more than 17 years, sibling donor HSCT was the only factor predicting a favorable result in multivariate analysis, possibly due to increased TRM resulting from unrelated donor HSCT.

Keyword

Acute lymphoblastic leukemia; Child; Second complete remission; Transplantation

MeSH Terms

Bone Marrow
Child
Cohort Studies
Disease-Free Survival
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Incidence
Male
Multivariate Analysis
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis
Recurrence
Siblings
Survival Rate
Tissue Donors
Transplants
Unrelated Donors