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Salvaged allogeneic hematopoietic stem cell transplantation for pediatric chemotherapy refractory acute leukemia
| Content Provider | Semantic Scholar |
|---|---|
| Author | Wang, Jingbo Yuan, Lei Cheng, Haoyu Fei, Xinhong Yin, Yumin Gu, Jiangying Xue, Song He, Junbao Yang, Fan Wang, Xiaocan Lucy Yang, Yixin Zhang, Weijie |
| Copyright Year | 2018 |
| Abstract | There is an ongoing debate concerning the performance of salvaged allogeneic hematopoietic stem cell transplantation (allo-HSCT) in pediatric patients with acute refractory leukemia, in whom the prognosis is quite dismal. Few studies have ever been conducted on this subject. This may be partly due to missed opportunities by majority of the patients in such situations. To investigate the feasibility, evaluate the efficiency, and identify the prognostic factors of allo-HSCT in this sub-setting, the authors performed a single institution-based retrospective analysis. A total of 44 patients, of whom 28 had acute myeloid leukemia (AML), 13 had acute lymphocytic leukemia (ALL), and 3 had mixed phenotype leukemia (MPL), were enrolled in this study. With a median follow-up of 19 months, the estimated 2-year overall survival (OS) and progression free survival (PFS) were 34.3% (95% CI, 17.9-51.4%) and 33.6% (95% CI, 18.0-50.1%), respectively. The estimated 2-year incidence rates of relapse and non-relapse mortality (NRM) were 43.8% (95% CI 26.4-60.0%) and 19.6% (95% CI 9.1-32.9%), respectively. The estimated 100-day cumulative incidence of acute graft versus host disease (aGvHD) was 43.6% (95% CI 28.7-57.5%), and the 1-year cumulative incidence of chronic GvHD (cGvHD) was 45.5% (95% CI 30.5-59.3%). Compared with the previous studies, the multivariate analysis in this study additionally identified that female donors and cGvHD were associated with lower relapse and better PFS and OS. Male recipients, age younger than 10 years, a diagnosis of ALL, and the intermediate-adverse cytogenetic risk group were associated with increased relapse. On the contrary, extramedullary disease (EMD) and aGvHD were only linked to worse PFS. These data suggested that although only one-third of the patients would obtain PFS over 2 years, salvaged allo-HSCT is still the most reliable and best therapeutic strategy for refractory pediatric acute leukemia. If probable, choosing a female donor, better management of aGvHD, and induction of cGvHD promotes patient survival. |
| Starting Page | 3143 |
| Ending Page | 3159 |
| Page Count | 17 |
| File Format | PDF HTM / HTML |
| PubMed reference number | 29423036v1 |
| Alternate Webpage(s) | https://doi.org/10.18632/oncotarget.22809 |
| DOI | 10.18632/oncotarget.22809 |
| Journal | Oncotarget |
| Volume Number | 9 |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Acute GVH disease Acute leukemia Acute lymphocytic leukemia Allo-tetrahydrocortisol:SCnc:Pt:Urine:Qn Allogeneic Hematopoietic Stem Cell Transplantation Chronic Graft Versus Host Disease Chronic Lymphocytic Leukemia Graft-vs-Host Disease Hematopoietic stem cells Leukemia, B-Cell Leukemia, Myelocytic, Acute Lymphoid leukemia Overall Survival Patients Probability Progression-Free Survival pediatric acute myeloblastic leukemia |
| Content Type | Text |
| Resource Type | Article |
