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Acute Leukemia

Outcome after failure of allogeneic hematopoietic stem cell transplantation in children with acute leukemia: a study by the société Francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC)

Bone Marrow Transplantation volume 52, pages 678–682 (2017)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplantation (SCT) contributes to improved outcome in childhood acute leukemia (AL). However, therapeutic options are poorly defined in the case of post-transplantation relapse. We aimed to compare treatment strategies in 334 consecutive children with acute leukemia relapse or progression after SCT in a recent 10-year period. Data could be analyzed in 288 patients (157 ALL, 123 AML and 8 biphenotypic AL) with a median age of 8.16 years at transplantation. The median delay from first SCT to relapse or progression was 182 days. The treatment consisted of chemotherapy alone (n=108), chemotherapy followed by second SCT (n=70), supportive/palliative care (n=67), combination of chemotherapy and donor lymphocyte infusion (DLI; n=30), or isolated reinfusion of donor lymphocytes (DLI; n=13). The median OS duration after relapse was 164 days and differed according to therapy: DLI after chemotherapy=385 days, second allograft=391 days, chemotherapy=174 days, DLI alone=140 days, palliative care=43 days. A second SCT or a combination of chemotherapy and DLI yielded similar outcome (hazard ratio (HR)=0.85, P=0.53) unlike chemotherapy alone (HR=1.43 P=0.04), palliative care (HR=4.24, P<0.0001) or isolated DLI (HR=1,94, P<0.04). Despite limitations in this retrospective setting, strategies including immunointervention appear superior to other approaches, mostly in AML.

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Acknowledgements

This work was supported by the Scientific Council of the Société Francophone de Greffe de Moelle et Thérapie Cellulaire. We thank Mrs Rachel Tipton for excellent secretary assistance.

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Authors and Affiliations

  1. Service d’Hématologie Centre Hospitalier Universitaire de Nice, Hôpital de l’Archet, Clinique, Nice, France

    C Roux

  2. Université de Nice-Sophia Antipolis, Nice, France

    C Roux & P-S Rohrlich

  3. Department of Public Health, CHU de Nice, Nice, France

    K Tifratene & C Pradier

  4. Hematology/Transplantation Unit, Saint Louis Hospital, Paris, France

    G Socié & R Peffault de Latour

  5. Pediatric Hematology Department, Hopital de La Timone, Marseille, France

    C Galambrun & G Michel

  6. Institute of Hematology and Oncology Paediatrics, Hospices Civils de Lyon, Lyon, France

    Y Bertrand

  7. Pediatric Hematology Department, CHU de Nantes, Nantes, France

    F Rialland

  8. Pediatric Onco-Hematology Department, Hôpital des Enfants, Bordeaux, France

    C Jubert

  9. Onco-Hematology Department, CHU Nancy-Brabois, Vandoeuvre les Nancy, France

    C Pochon

  10. Pediatric Onco-Hematology Department, CHU de Strasbourg, Strasbourg, France

    C Paillard

  11. Pediatric Onco-Hematology Department, CHU de Montpellier, Montpellier, France

    A Sirvent

  12. Department of Pediatric Hematology-Oncology, Jeanne de Flandre Hospital, CHRU, Lille, France

    B Nelken

  13. Pediatric Onco-Hematology Department, CHU de Rouen, Rouen, France

    J P Vannier

  14. Pediatric Onco-Hematology Department, CHU de Grenoble, Grenoble, France

    C Freycon

  15. Haematology Department, CHU of Liège and University of Liège, Liège, Belgium

    Y Beguin

  16. Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Lyon, France

    N Raus

  17. Hematology Department, CHRU de Lille, Lille, France

    I Yakoub-Agha

  18. Hematology Department, Saint-Antoine Hospital, Paris, France

    M Mohty

  19. Pediatric Hematology Department, Hopital Robert Debré, Paris, France

    J-H Dalle

  20. Pediatric Hematology-Oncology Department, Hôpital l’Archet, CHU de Nice, Nice, France

    P-S Rohrlich

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  1. C Roux
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  2. K Tifratene
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  14. Y Beguin
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Correspondence to P-S Rohrlich.

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Roux, C., Tifratene, K., Socié, G. et al. Outcome after failure of allogeneic hematopoietic stem cell transplantation in children with acute leukemia: a study by the société Francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC). Bone Marrow Transplant 52, 678–682 (2017). https://doi.org/10.1038/bmt.2016.360

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