Premium
Autologous purified peripheral blood stem cell transplantation compare to chemotherapy in childhood acute lymphoblastic leukemia after low‐risk relapse
Author(s) -
Balduzzi Adriana,
Galimberti Stefania,
Valsecchi Maria G.,
Bonanomi Sonia,
Conter Valentino,
Barth Andrea,
Rovelli Attilio,
Henze Günter,
Biondi Andrea,
von Stackelberg Arend
Publication year - 2011
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.23169
Subject(s) - medicine , chemotherapy , transplantation , total body irradiation , acute lymphocytic leukemia , leukemia , surgery , oncology , hematopoietic stem cell transplantation , stem cell , induction chemotherapy , gastroenterology , lymphoblastic leukemia , cyclophosphamide , biology , genetics
Background The treatment of childhood B‐cell precursor acute lymphoblastic leukemia (ALL) after isolated extramedullary or late relapse is mostly based on chemotherapy or allogeneic transplantation. The aim of this study is to provocatively assess the role of purified autologous transplantation compared with best chemotherapy results in the same setting. Procedure We reported a series of 30 pediatric patients who underwent purified peripheral blood autologous transplantation for ALL in CR2, after isolated extramedullary (7), or late medullary (23) relapse from January 1997 and March 2004. Among 246 patients treated with chemotherapy within Berlin–Frankfurt–Münster relapse protocols during the same period, we found 103 controls who matched our 30 cases, according to site of relapse, CR1 duration, time elapsed in CR2, and period of relapse. Results Event‐free survival and survival at 5 years after relapse were 73.3% (SE 8.1) and 86.5% (SE 8.2) for auto‐transplanted cases and 40.0% (SE 9.7) and 62.5%(SE 9.6) for chemotherapy‐treated controls ( P ‐values: 0.012 and 0.025, respectively). The risk of relapse after auto‐transplantation at 1 and 4 years was approximately half and one‐fifth, respectively, of the same risk obtained with chemotherapy. Conclusions This matched analysis showed an advantage of purified autologous transplantation compared with chemotherapy in low‐risk relapsed ALL, possibly explained by the single‐center effect, the myeloablation of total body irradiation, the documented low tumor burden at mobilization and the stem cell isolation procedure. Pediatr Blood Cancer 2011; 57: 654–659. © 2011 Wiley‐Liss, Inc.