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Jang W, Jo S, Yoo JW, Kim S, Lee JW, Jang PS, Chung NG, Cho B. Prognostic impact of total body irradiation dose in pediatric acute lymphoblastic leukemia patients treated with allogeneic hematopoietic stem cell transplantation in second complete remission. Blood Res 2022; 57:256-263. [PMID: 36535640 PMCID: PMC9812732 DOI: 10.5045/br.2022.2022174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Allogeneic HSCT may improve survival in pediatric ALL patients who relapse. In this study, we analyzed the outcome and prognostic factors of 62 ALL patients (35 male, 56.5%) who received allogeneic HSCT in second complete remission (CR) at our institution between April 1st 2009 and December 31st 2019. Methods The median time from diagnosis to relapse was 35.1 months (range, 6.0‒113.6 mo). Fifty-three patients (85.5%) experienced bone marrow relapse only. The number of patients who received transplant according to each donor type was as follows: HLA matched family donor 17 (27.4%), matched unrelated donor (UD) 22 (35.5%), mismatched donor 23 (37.1%). All patients received HSCT with a myeloablative conditioning, 58 patients (93.5%) with the incorporation of TBI [31 patients 12 Gray (Gy), 24 patients 13.2 Gy, 3 patients 8 Gy]. Results The 5-year event-free survival (EFS), and overall survival of the study group was 41.3±6.3% (26/62), and 42.3±6.6% (27/62), respectively. The cumulative incidence of relapse and transplant-related mortality was 57.1±6.4% and 1.6±1.6%, respectively. Infant ALL, shorter time from diagnosis to relapse, and TBI dose of 12 Gy, rather than 13.2 Gy, resulted in significantly worse EFS. In multivariate analysis, infant ALL and TBI dose of 12 Gy during conditioning predicted significantly lower EFS. Conclusion In our study group, treatment with a higher dose of TBI during conditioning resulted in better EFS for ALL patients who underwent HSCT in second CR. Further study is needed to determine potential long-term complications associated with a higher TBI dose.
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Affiliation(s)
- Wonjin Jang
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suejung Jo
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Won Yoo
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seongkoo Kim
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea,Correspondence to, Jae Wook Lee, M.D., Ph.D., Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Banpo-daero 222, Seoul 06591, Korea, E-mail:
| | - Pil-Sang Jang
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack-Gyun Chung
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee JW, Cho B. Prognostic factors and treatment of pediatric acute lymphoblastic leukemia. KOREAN JOURNAL OF PEDIATRICS 2017; 60:129-137. [PMID: 28592975 PMCID: PMC5461276 DOI: 10.3345/kjp.2017.60.5.129] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 12/13/2022]
Abstract
The event-free survival (EFS) for pediatric acute lymphoblastic leukemia (ALL) has shown remarkable improvement in the past several decades. In Korea also, a recent study showed 10-year EFS of 78.5%. Much of the improved outcome for pediatric ALL stems from the accurate identification of prognostic factors, the designation of risk group based on these factors, and treatment of appropriate duration and intensity according to risk group, done within the setting of cooperative clinical trials. The schema of first-line therapy for ALL remains mostly unchanged, although many groups have now reported on the elimination of cranial irradiation in all patients with low rates of central nervous system relapse. Specific high risk subgroups, such as Philadelphia chromosome-positive (Ph+) ALL and infant ALL continue to have significantly lower survival than other ALL patients. The introduction of tyrosine kinase inhibitors into therapy has led to enhanced outcome for Ph+ ALL patients. Infant ALL patients, particularly those with MLL rearrangements, continue to have poor outcome, despite treatment intensification including allogeneic hematopoietic cell transplantation. Relapsed ALL is a leading cause of mortality in pediatric cancer. Recent advances in immunotherapy targeting the CD19 of the ALL blast have shown remarkable efficacy in some of these relapsed and refractory patients. With improved survival, much of the current focus is on decreasing the long-term toxicities of treatment.
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Affiliation(s)
- Jae Wook Lee
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Bin Cho
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, College of Medicine, Seoul, Korea
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3
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El-Cheikh J, Crocchiolo R, Furst S, Bramanti S, Sarina B, Granata A, Vai A, Lemarie C, Faucher C, Mohty B, Harbi S, Bouabdallah R, Vey N, Santoro A, Chabannon C, Castagna L, Blaise D. Unrelated cord blood compared with haploidentical grafts in patients with hematological malignancies. Cancer 2015; 121:1809-16. [PMID: 25649994 DOI: 10.1002/cncr.29271] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/28/2014] [Accepted: 12/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alternative donors, such as unrelated umbilical cord blood (UCB) and related haploidentical (haplo) donors, are more and more frequently searched for and used for patients who are candidates for allogeneic hematopoietic stem cell transplantation but are without a suitable related or unrelated donor. The aim of the current retrospective study was to compare the outcome of patients after haplo and UCB grafts prepared using a nonmyeloablative conditioning regimen. METHODS A total of 150 adult patients with high-risk hematologic diseases who underwent allogeneic hematopoietic stem cell transplantation from alternative donors at 2 centers (Paoli-Calmettes Institute [Marseille, France] and Humanitas Cancer Center [Milan, Italy]) were analyzed. Sixty-nine patients had haplo donors and 81 patients had UCB donors. RESULTS The cumulative incidence of nonrecurrence mortality at 1 year was 23% in the UCB group versus 17% in the haplo group (P = .39). The incidence of grade 2 to 4 acute graft-versus-host disease and extensive chronic graft-versus-host disease in the UCB group versus the haplo group was 52% versus 29% (P = .05) and 12% versus 6% (P<.0001), respectively. The overall survival rate at 2 years was 45% in the UCB group (95% confidence interval [95% CI], 34%-56%) versus 69% in the haplo group (95% CI, 58%-80%) (P = .10). The progression-free survival rate at 2 years was 36% in the UCB group (95% CI, 25%-47%) versus 65% in the haplo group (95% CI, 53%-77%) (P = .01). CONCLUSIONS The results of the current study suggest that for patients with high-risk hematological diseases without a related or unrelated donor, haploidentical transplants are a promising alternative option that deserves further investigation.
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Affiliation(s)
- Jean El-Cheikh
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | | | - Sabine Furst
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Angela Granata
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | | | - Claude Lemarie
- Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Cellular Therapy Center, Paoli-Calmettes Institute, Marseille, France
| | - Catherine Faucher
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Bilal Mohty
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Samia Harbi
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Reda Bouabdallah
- Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Norbert Vey
- Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France.,Cancer Research Center of Marseille, Marseille, France
| | | | - Christian Chabannon
- Cellular Therapy Center, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France.,Cancer Research Center of Marseille, Marseille, France
| | - Luca Castagna
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Humanitas Cancer Center, Milan, Italy
| | - Didier Blaise
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France.,Cancer Research Center of Marseille, Marseille, France
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Chen Y, Xu Y, Fu G, Liu Y, Peng J, Fu B, Yuan X, Xin H, Zhu Y, He Q, Wu D, Shu Y, Li X, Zhao X, Chen F. Allogeneic hematopoietic stem cell transplantation for patients with acute leukemia. Chin J Cancer Res 2013; 25:389-96. [PMID: 23997525 DOI: 10.3978/j.issn.1000-9604.2013.07.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/25/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purposes of this study were to assess the efficacy of allogeneic hematopoietic stem cell transplantation (HSCT) for acute leukemia (AL) and analyze the factors affecting the prognosis of these patients. METHODS The clinical and follow-up data of 93 AL patients (median age, 30 years) undergoing allogeneic HSCT in Xiangya Hospital over the past 12 years were collected, and the potential factors affecting the efficacy and prognosis of allogeneic HSCT patients were determined. RESULTS Hematopoietic reconstitution was achieved in 90 patients. At the last follow-up, the incidences of severe acute graft versus host disease (aGvHD) and extensive chronic GvHD (cGvHD) were 14.0% and 20.0%, the 3-year cumulative incidence of transplantation related mortality (TRM) and relapse rate were 16.8%±6.1% and 21.3%±6.7%, and the estimated 3-year overall survival (OS) and disease-free survival (DFS) of the patients were 64.6%±5.4% and 56.5%±5.5%, respectively. Univariate analysis indicated that age older than 40 years, HLA mismatch, and severe lung infection within the first 100 days after transplantation were risk factors for severe aGvHD, age older than 40 years, HLA mismatch, severe lung infection within the first 100 days after transplantation, and severe aGvHD were risk factors for TRM, high-risk AL and lack of cGvHD were risk factors for relapse (all P<0.05). Survival estimation showed that HLA mismatch, severe lung infection occurring within the first 100 days post-transplantation, high-risk AL severe aGvHD and lack of cGvHD were risk factors associated with poor prognosis (all P<0.05). Further multivariate analyses revealed that severe lung infection within the first 100 days post-transplantation, severe aGvHD and lack of cGvHD were independent risk factors for unfavorable outcomes (all P<0.05). CONCLUSIONS Allogeneic HSCT can improve the DFS of AL patients, and severe lung infection within the first 100 days post-transplantation, severe aGvHD and lack of cGvHD are independent risk factors affecting the prognosis.
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Affiliation(s)
- Yan Chen
- Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008, China
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