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Outcome of hematopoietic stem cell transplantation for pediatric patients with therapy‐related acute myeloid leukemia or myelodysplastic syndrome
Author(s) -
Woodard Paul,
Barfield Raymond,
Hale Gregory,
Horwitz Edwin,
Leung Wing,
Ribeiro Raul,
Rubnitz Jeffrey,
Srivistava Deo Kumar,
Tong Xin,
Yusuf Usman,
Raimondi Susana,
Pui ChingHon,
Handgretinger Rupert,
Cunningham John M.
Publication year - 2006
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20596
Subject(s) - medicine , myeloid leukemia , hematopoietic stem cell transplantation , myelodysplastic syndromes , disease , transplantation , sibling , oncology , leukemia , bone marrow , acute leukemia , immunology , gastroenterology , psychology , developmental psychology
Background Therapy‐related myelodysplastic syndrome (t‐MDS) and acute myeloid leukemia (t‐AML) carry a poor prognosis. We analyzed the results of allogeneic HSCT in 38 children to determine which factors, if any, affected outcome. Procedure The effects of demographic, donor, and disease‐related factors were analyzed to determine their effects on overall and disease‐free survival (OS, DFS), relapse, and non‐relapse mortality (NRM). Results OS and DFS for t‐AML and t‐MDS were similar. Three‐year OS and EFS were the same (15.4 ± 5.8%) and the 3‐year NRM was 59.6 ± 8.4%. The 1‐year cumulative risk of grade III–IV acute graft‐versus‐host disease (GVHD) and relapse were 23.7 ± 7.0% and 18.7 ± 6.5%, respectively. The percentage of pre‐transplant bone marrow (BM) blasts was positively associated with relapse ( P = 0.05), while the percentage of BM blasts at diagnosis of therapy‐related disease tended to associate with NRM ( P = 0.07). Alternative donor and matched sibling donor grafts had similar outcomes. NRM was higher among patients who did not develop acute GVHD as compared to those with grade 1–2 acute GVHD (69.2 ± 14.2% vs. ± 12.7%, respectively), while NRM was 100% in patients with grade III–IV acute GVHD ( P = 0.007). Conclusions The percentage of BM blasts is associated with relapse in these disorders. High rates of NRM negatively impact the outcome of allogeneic HSCT for children with t‐AML and t‐MDS. Future studies should focus on reducing NRM. © 2005 Wiley‐Liss, Inc.