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Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children

Bone Marrow Transplantation volume 54, pages 275–283 (2019)Cite this article

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Abstract

Relapse of acute lymphoblastic leukemia (ALL) may occur in extramedullary sites, mainly central nervous system (CNS) and testis. Optimal post-remissional treatment for isolated extramedullary relapse (IEMR) is still controversial. We collected data of children treated with hematopoietic stem cell transplantation (HSCT) for ALL IEMR from 1990 to 2015 in Italy. Among 281 patients, 167 had a relapse confined to CNS, 73 to testis, 14 to mediastinum, and 27 to other organs. Ninety-seven patients underwent autologous HSCT, 79 received allogeneic HSCT from a matched family donor, 75 from a matched unrelated donor, and 30 from an HLA-haploidentical donor. The 10-year overall survival was 56% and was not influenced by gender, ALL blast immune-phenotype, age, site of relapse, duration of first remission, and type of HSCT. In multivariable analysis, the only prognostic factors were disease status at HSCT and year of transplantation. Patients transplanted in third or subsequent complete remission (CR) had a risk of death 2.3 times greater than those in CR2. Children treated after 2000 had half the risk of death than those treated before that year. Our results suggest that both autologous and allogeneic HSCT may be considered for the treatment of pediatric ALL IEMR after the achievement of CR2.

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Acknowledgments

We are grateful to Dr. Veronica Tintori (Bone Marrow Transplant Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy) and to Dr. Gabriella Casazza (U.O. Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria di Pisa, Italy) for providing patients’ data.

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Authors and Affiliations

  1. Oncoematologia Pediatrica, Università di Padova, Padova, Italy

    Maria Gabelli, Chiara Messina, Elisa Carraro, Barbara Buldini & Giuseppe Basso

  2. Oncoematologia Pediatrica, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

    Marco Zecca

  3. Ematologia Pediatrica, Ospedale San Gerardo, Monza, Italy

    Attilio Maria Rovelli

  4. Oncoematologia Pediatrica, Ospedale Regina Margherita, Azienda Ospedaliero Universitaria, Torino, Italy

    Franca Fagioli

  5. Oncoematologia Pediatrica, I.R.C.C.S. Ospedale Pediatrico Bambino Gesù, Roma, Italy

    Alice Bertaina & Franco Locatelli

  6. Centro Trapianti Midollo Osseo, I.R.C.C.S. Giannina Gaslini, Genova, Italy

    Edoardo Lanino

  7. Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy

    Claudio Favre

  8. Oncoematologia Pediatrica, I.R.C.C.S. Materno Infantile Burlo Garofalo, Trieste, Italy

    Marco Rabusin

  9. Oncologia ed Ematologia Pediatrica “Lalla Seragnoli”, Policlinico Sant’Orsola Malpighi, Bologna, Italy

    Arcangelo Prete

  10. Trapianto di Midollo Osseo, Azienda Ospedaliera Santobono Pausilipon, Napoli, Italy

    Mimmo Ripaldi

  11. Divisione di Ematologia, Università La Sapienza, Roma, Italy

    Walter Barberi

  12. Oncoematologia Pediatrica e Trapianto di Midollo Osseo Pediatrico, Spedali Civili di Brescia, Brescia, Italy

    Fulvio Porta

  13. Oncoematologia Pediatrica, Azienda Ospedaliera di Perugia, Perugia, Italy

    Maurizio Caniglia

  14. Dipartimento di Ematologia, Ospedale di Pescara, Pescara, Italy

    Stella Santarone

  15. Oncoematologia Pediatrica, A.R.N.A.S. Civico, Di Cristina e Benfratelli, Palermo, Italy

    Paolo D’Angelo

  16. Dipartimento di Scienze Pediatriche, Università di Pavia, Pavia, Italy

    Franco Locatelli

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  1. Maria Gabelli
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  2. Marco Zecca
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  8. Alice Bertaina
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  14. Walter Barberi
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  15. Fulvio Porta
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  16. Maurizio Caniglia
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  19. Giuseppe Basso
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  20. Franco Locatelli
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Correspondence to Maria Gabelli.

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Gabelli, M., Zecca, M., Messina, C. et al. Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children. Bone Marrow Transplant 54, 275–283 (2019). https://doi.org/10.1038/s41409-018-0259-5

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