Summary:
We analyzed the outcome of 167 consecutive children with second CR acute lymphoblastic leukemia (ALL), for whom an unrelated donor (UD) search was activated between 1989 and 1998 at a median time of 2 months after relapse. A suitable donor was identified for 70 patients at 1 year and 6.5 months before and after 1995 from search activation, respectively; a further leukemia relapse occurred during the search in 94 children at a median of 4 months after search activation, 36 of whom underwent UD (14) or other types of transplant (22), beyond second CR, while 58 died of progressive disease. Of 73 patients not experiencing a second relapse, 64 underwent UD (46) or other types of transplant (18), while nine proceeded with chemotherapy, and only four of them survived. The 3-year disease-free survival (DFS) from second CR for the 167 patients is 15.1%, whereas 3-year DFS after transplant for the 60 UD and 40 alternative donor transplanted children is 31.6 and 25.4%, respectively. In conclusion, a further relapse is the main factor adversely affecting outcome of children with second CR ALL. Thus, for these patients, the search should be activated early after relapse and either a UD or an alternative transplant should be performed as early as possible.
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Acknowledgements
We would like to thank data managers from all the centers for their help in collecting data and answering our queries; Roberta Cancedda from G Gaslini Institute (Genova); Francesca Predieri from CO FONOP-AIEOP (Bologna) for their assistance with data management; partially supported by Ricerca Finalizzata 2002, by Compagnia San Paolo, by Fondazione CARIGE.
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Dini, G., Valsecchi, M., Micalizzi, C. et al. Impact of marrow unrelated donor search duration on outcome of children with acute lymphoblastic leukemia in second remission. Bone Marrow Transplant 32, 325–331 (2003). https://doi.org/10.1038/sj.bmt.1704132
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DOI: https://doi.org/10.1038/sj.bmt.1704132
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