Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia

Troy C. Lund, Kwang Woo Ahn, Heather R. Tecca, Megan V. Hilgers, Hisham Abdel-Azim, Allistair Abraham, Miguel Angel Diaz, Sherif M. Badawy, Larisa Broglie, Valerie Brown, Christopher C. Dvorak, Marta Gonzalez-Vicent, Hasan Hashem, Robert J. Hayashi, David A. Jacobsohn, Michael W. Kent, Chi kong Li, Steven P. Margossian, Paul L. Martin, Parinda MehtaKasiani Myers, Richard Olsson, Kristin Page, Michael A. Pulsipher, Peter J. Shaw, Angela R. Smith, Brandon M. Triplett, Michael R. Verneris, Mary Eapen

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Children with acute leukemia who relapse after hematopoietic cell transplantation (HCT) have few therapeutic options. We studied 251 children and young adults with acute myelogenous or lymphoblastic leukemia who underwent a second HCT for relapse after their first HCT. The median age at second HCT was 11 years, and the median interval between first and second HCT was 17 months. Most of the patients (n = 187; 75%) were in remission, received a myeloablative conditioning regimen (n = 157; 63%), and underwent unrelated donor HCT (n = 230; 92%). The 2-year probability of leukemia-free survival (LFS) was 33% after transplantation in patients in remission, compared with 19% after transplantation in patients not in remission (P =.02). The corresponding 8-year probabilities were 24% and 10% (P =.003). A higher rate of relapse contributed to the difference in LFS. The 2-year probability of relapse after transplantation was 42% in patients in remission and 56% in those in relapse (P =.05). The corresponding 8-year probabilities were 49% and 64% (P =.04). These data extend the findings of others showing that patients with a low disease burden are more likely to benefit from a second transplantation. Late relapse led to a 10% decrement in LFS beyond the second year after second HCT. This differs from first HCT, in which most relapses occur within 2 years after HCT.

Original languageEnglish
Pages (from-to)301-306
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number2
DOIs
StatePublished - Feb 2019

Keywords

  • relapse acute leukemia second transplant

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