Aygüneş Utku, Karagün Barbaros Şahin, Şaşmaz Ilgen, Antmen Ali Bülent
Department of Pediatric Hematology-Oncology & Bone Marrow Transplantation, Acibadem Adana Hospital, Adana, Turkey.
Department of Pediatric Hematology-Oncology, Adana City Training and Research Hospital, Adana, Turkey.
Clin Transplant. 2024 May;38(5):e15366. doi: 10.1111/ctr.15366.
In children with high-risk childhood acute leukemia who undergo allogeneic hematopoietic stem-cell transplantation (allo-HSCT), relapse is still the leading cause of treatment failure. The prognosis is poor, yet prospective studies have only limited data on risk factors and outcomes. We aimed to understand the outcomes and prognostic factors for patients with acute lymphoblastic leukemia (ALL) who relapsed following allo-HSCT. We analyzed retrospectively 46 children with childhood acute lymphoblastic leukemia who had relapsed after receiving their first alloHSCT. All these patients received salvage chemotherapy which consisted of fludarabine, cytarabine, and idarubicin before performing a second alloHSCT. The median follow-up of the 46 patients after the first transplantation was 366 days. The median time from first allo-HSCT to relapse was 278.4 ± 238.4 days. Forty-six patients received salvage chemotherapy before the second alloHSCT, and CR was achieved in 32 of 46 patients. However, only 17 (37%) of 46 patients received a second allo-HSCT, and 15 of 46 patients died from disease progression, infections, and bleeding. Twelve patients are still alive after the second allo-HSCT. Two-year overall survival (OS) was 38.9%. Local therapy was given to 10 (21.8%) patients, either as part of systemic therapy or alone. In multivariate analyses, the time of relapse and curative salvage therapy with a second allo-HSCT were identified as significant prognostic factors for OS. Children with leukemia who had relapsed after the first allo-HSCT received salvage chemotherapy. Our statistical analysis showed that the second HSCT could be beneficial for outcomes if patients relapsed beyond 180 days of the first allo-HSCT.
在接受异基因造血干细胞移植（allo-HSCT）的高危儿童急性白血病患者中，复发仍是治疗失败的主要原因。预后较差，但前瞻性研究关于风险因素和结局的数据有限。我们旨在了解异基因造血干细胞移植后复发的急性淋巴细胞白血病（ALL）患者的结局和预后因素。我们回顾性分析了46例首次接受异基因造血干细胞移植后复发的儿童急性淋巴细胞白血病患者。所有这些患者在进行第二次异基因造血干细胞移植前均接受了由氟达拉滨、阿糖胞苷和伊达比星组成的挽救性化疗。46例患者首次移植后的中位随访时间为366天。从首次异基因造血干细胞移植到复发的中位时间为278.4±238.4天。46例患者在第二次异基因造血干细胞移植前接受了挽救性化疗，46例患者中有32例达到完全缓解（CR）。然而，46例患者中只有17例（37%）接受了第二次异基因造血干细胞移植，46例患者中有15例死于疾病进展、感染和出血。12例患者在第二次异基因造血干细胞移植后仍存活。两年总生存率（OS）为38.9%。10例（21.8%）患者接受了局部治疗，作为全身治疗的一部分或单独进行。在多变量分析中，复发时间和第二次异基因造血干细胞移植的根治性挽救治疗被确定为总生存率的重要预后因素。首次异基因造血干细胞移植后复发的白血病患儿接受了挽救性化疗。我们的统计分析表明，如果患者在首次异基因造血干细胞移植180天后复发，第二次造血干细胞移植可能对结局有益。
