Results and factors influencing outcome after fully haploidentical hematopoietic stem cell transplantation in children with very high-risk acute lymphoblastic leukemia: impact of center size: an analysis on behalf of the Acute Leukemia and Pediatric Disea

Abstract:

:T cell-depleted haploidentical hematopoietic stem cell transplantation (haploHSCT) is an option to treat children with very high-risk acute lymphoblastic leukemia (ALL) lacking an HLA-identical donor. We analyzed 127 children with ALL who underwent haploHSCT in first (n = 22), second (n = 48), or third (n = 32), complete remission or in relapse (n = 25). The 5-year leukemia-free survival (LFS) was 30%, 34%, 22%, and 0%, respectively. A risk-factor analysis was performed for patients who underwent transplantation in remission (n = 102). Five-year nonrelapse mortality (NRM), relapse incidence (RI), and LFS were 37%, 36%, and 27%, respectively. A trend of improved LFS rate and decreased RI was observed for children given a graft with higher number of CD34(+) cells (adjusted P = .09 and P = .07, respectively). In a multivariate analysis, haploHSCT performed in larger centers (performing > or = 231 allotransplantations in the studied period) was associated with improved LFS rate and decreased RI (adjusted P = .01 and P = .04, respectively), adjusting for different patient-, disease-, and transplant-related factors such as number of previous autotransplantations, cytomegalovirus serology status, type of T-cell depletion, and use of total body irradiation and antithymocyte globulin. In conclusion, higher CD34(+) cell dose and better patient selection may improve outcomes of children with ALL who undergo a haploHSCT. Transplant centers initiating programs on haploHSCT for children may collaborate with more experienced centers.

journal_name

Blood

journal_title

Blood

authors

Klingebiel T,Cornish J,Labopin M,Locatelli F,Darbyshire P,Handgretinger R,Balduzzi A,Owoc-Lempach J,Fagioli F,Or R,Peters C,Aversa F,Polge E,Dini G,Rocha V,Pediatric Diseases and Acute Leukemia Working Parties of the Europe

doi

10.1182/blood-2009-03-207001

subject

Has Abstract

pub_date

2010-04-29 00:00:00

pages

3437-46

issue

17

eissn

0006-4971

issn

1528-0020

pii

blood-2009-03-207001

journal_volume

115

pub_type

临床试验,杂志文章,多中心研究

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