Current Allogeneic Hematopoietic Stem Cell Transplantation for Pediatric Acute Lymphocytic Leukemia: Success, Failure and Future Perspectives—A Single-Center Experience, 2008 to 2016

Asaf D. Yanir, Caridad A. Martinez, Ghadir Sasa, Kathryn Leung, Stephen Gottschalk, Bilal Omer, Nabil Ahmed, Meenakshi Hegde, Jo Eunji, Hao Liu, Helen E. Heslop, Malcolm K. Brenner, Robert A. Krance, Swati Naik

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Hematopoietic stem cell transplantation (HSCT) is the only curative option for a subset of patients with high-risk or relapsed acute lymphoblastic leukemia (ALL). Given evolving practices, it is important to continually evaluate outcomes for pediatric ALL following HSCT. Outcomes after HSCT are influenced by the type of donor used as this determines the degree and method of T cell depletion used and, consequently, specific transplant-related morbidities. We retrospectively analyzed HSCT data from our center for transplants performed between January 2008 and May 2016, comparing outcomes among different donor types. One hundred and twenty-four pediatric patients underwent HSCT from a matched sibling donor (MSD; n = 48), an unrelated matched donor (UMD; n = 56), or a haploidentical donor (n = 20). We observed a similar 3-year event-free survival (EFS) for MSD recipients (of.64) and for UMD recipients (.62), but a significantly lower EFS for recipients of haploidentical transplants (.35; P =.01). Relapse was the main cause of HSCT failure and was significantly higher in the haploidentical donor group (.47 versus.19 for MSD and.24 for UMD; P =.02). Treatment-related mortality was evenly distributed among the donor groups (.17,.16, and.15 for the MSD, UMD, and haploidentical groups, respectively). Rates of infection-related mortality were lower than previously reported. Relapse is the main obstacle for successful HSCT in the contemporary era, and this effect is most evident in recipients of haploidentical donor grafts. Newer methods to improve graft-versus-leukemia effect are being evaluated and will need to be incorporated into the management of high-risk patients.

Original languageEnglish (US)
Pages (from-to)1424-1431
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number7
DOIs
StatePublished - Jul 2018
Externally publishedYes

Keywords

  • ALL
  • Alternative donors
  • Conditioning
  • Haploidentical
  • Minimal residual disease
  • Relapse

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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  • Cite this

    Yanir, A. D., Martinez, C. A., Sasa, G., Leung, K., Gottschalk, S., Omer, B., Ahmed, N., Hegde, M., Eunji, J., Liu, H., Heslop, H. E., Brenner, M. K., Krance, R. A., & Naik, S. (2018). Current Allogeneic Hematopoietic Stem Cell Transplantation for Pediatric Acute Lymphocytic Leukemia: Success, Failure and Future Perspectives—A Single-Center Experience, 2008 to 2016. Biology of Blood and Marrow Transplantation, 24(7), 1424-1431. https://doi.org/10.1016/j.bbmt.2018.03.001