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Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia
Author(s) -
Hazar Volkan,
Tezcan Karasu Gülsün,
Öztürk Gülyüz,
Küpesiz Alphan,
Aksoylar Serap,
Özbek Namık,
Uygun Vedat,
İleri Talia,
Okur Fatma Visal,
Koçak Ülker,
Kılıç Suar Çakı,
Akçay Arzu,
Güler Elif,
Kansoy Savaş,
Karakükcü Musa,
Bayram İbrahim,
Aksu Tekin,
Yeşilipek Akif,
Karagün Barbaros Şahin,
Yılmaz Şebnem,
Ertem Mehmet,
Uçkan Duygu,
Fışgın Tunç,
Gürsel Orhan,
Yaman Yöntem,
Bozkurt Ceyhun,
Gökçe Müge
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13942
Subject(s) - medicine , hazard ratio , hematopoietic stem cell transplantation , transplantation , salvage therapy , acute leukemia , cohort , retrospective cohort study , leukemia , surgery , oncology , chemotherapy , confidence interval
Abstract Background Post‐transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Data on risk factors, treatment options, and outcomes are limited. Procedure In this retrospective multicenter study in which a questionnaire was sent to all pediatric transplant centers reporting relapse after allo‐HSCT for a cohort of 938 children with acute leukemia, we analyzed 255 children with relapse of acute leukemia after their first allo‐HSCT. Results The median interval from transplantation to relapse was 180 days, and the median follow‐up from relapse to the last follow‐up was 1844 days. The 3‐year overall survival (OS) rate was 12.0%. The main cause of death was disease progression or subsequent relapse (82.6%). The majority of children received salvage treatment with curative intent without a second HSCT (67.8%), 22.0% of children underwent a second allo‐HSCT, and 10.2% received palliative therapy. Isolated extramedullary relapse (hazard ratio (HR): 0.607, P = .011) and relapse earlier than 365 days post‐transplantation (HR: 2.101, P < .001 for 0‐180 days; HR: 1.522, P = .041 for 181‐365 days) were found in multivariate analysis to be significant prognostic factors for outcome. The type of salvage therapy in chemosensitive relapse was identified as a significant prognostic factor for OS. Conclusion A salvage approach with curative intent may be considered for patients with post‐transplant relapse, even if they relapse in the first year post‐transplantation. For sustainable remission, a second allo‐HSCT may be recommended for patients who achieve complete remission after reinduction treatment.