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Therapy of pediatric ALL relapsing after allogeneic transplant: how to make progress with limited patient numbers?

Bone Marrow Transplantation volume 52, pages 197–198 (2017)Cite this article

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In this issue of Bone Marrow Transplantation, Willasch et al. describe their single-center experience in a 10-year period, in a group of 101 children transplanted for ALL, looking at relapse after allo-SCT and evaluating its treatment. In Europe, transplanting 10 children with ALL yearly represents a considerable number of patients. Twenty-three patients developed a relapse post allo-SCT in this report, 2.3 per year. The numbers issue is immediately clear.

What new therapeutic developments have we witnessed over a decade, and what does the future look like? We have learned that minimal residual disease (more appropriately: measurable residual disease) at transplant is highly predictive of relapse post transplant1, 2 and have started acting on it, combining new (for example, clofarabin) and old drugs. We are studying in Europe and beyond whether a non-irradiation conditioning regimen is as effective as total body irradiation, in an attempt to reduce late effects, the so-called FORUM study (clinicaltrials.gov NCT01949129). There is substantial but no final evidence that this approach will be feasible. It remains to be evaluated what the optimal chemo-conditioning regimen is.

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  1. Department of Hematology and Stem Cell Transplantation, Utrecht University Children’s Hospital, Het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands

    M Bierings

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Correspondence to M Bierings.

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Bierings, M. Therapy of pediatric ALL relapsing after allogeneic transplant: how to make progress with limited patient numbers?. Bone Marrow Transplant 52, 197–198 (2017). https://doi.org/10.1038/bmt.2016.276

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