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Pediatric Transplants

Allogeneic hematopoietic cell transplantation outcomes for children with B-precursor acute lymphoblastic leukemia and early or late BM relapse

Bone Marrow Transplantation volume 46, pages 950–955 (2011)Cite this article

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Abstract

Large registry studies have shown superior disease-free survival (DFS) with matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT) over chemotherapy alone for patients with B-precursor acute lymphoblastic leukemia (ALL) and a late BM relapse. As most of these patients will not have an MSD, the decision to pursue an unrelated allo-HCT in second remission (CR2) or await a future relapse and perform HCT in third remission (CR3) continues to be debated. Between 1990 and 2006, 41 children with relapsed B-precursor ALL received a myeloablative allo-HCT at the University of Minnesota. Graft sources consisted of matched related donor (n=11), matched unrelated donor (n=9), and unrelated umbilical cord blood (n=21). Before allo-HCT, 15 patients had an early relapse (<36 months from diagnosis) and 26 had an initial late relapse (⩾36 months from diagnosis). In all, 30 patients (73%) were in CR2 and 11 were in CR3 (27%) at time of allo-HCT. Five year OS/DFS were similar for patients with an early or late marrow relapse, but there was inferior DFS among late-relapse patients transplanted in CR3 compared with CR2 (30% vs 75%, P=0.04). These results suggest that allo-HCT should be pursued in children after a first marrow relapse, rather than waiting for subsequent recurrence.

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Acknowledgements

This work was supported by the Children's Cancer Research Fund (CCRF) and the University of Minnesota Pediatric Leukemia Program.

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Authors and Affiliations

  1. Division of Pediatric Hematology/Oncology/Bone and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA

    J C Beck, B Trotz, A R Smith, B J Weigel, M R Verneris & M J Burke

  2. Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA

    Q Cao

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  1. J C Beck
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  2. Q Cao
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  3. B Trotz
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  4. A R Smith
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  7. M J Burke
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Correspondence to M J Burke.

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Beck, J., Cao, Q., Trotz, B. et al. Allogeneic hematopoietic cell transplantation outcomes for children with B-precursor acute lymphoblastic leukemia and early or late BM relapse. Bone Marrow Transplant 46, 950–955 (2011). https://doi.org/10.1038/bmt.2010.217

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