Hematopoietic stem cell transplantation in pediatric patients with acute myeloid leukemia without favorable cytogenetics

Abstract

Intensified chemotherapy, HSCT, and supportive care improve the survival of pediatric patients with AML. However, no consensus has been reached regarding the role of HSCT in patients without favorable cytogenetics. We evaluated OS and EFS according to prognostic factors that affect clinical outcomes, including cytogenetics risk group, conditioning regimen, donor type, disease status at the time of HSCT, and number of chemotherapy cycles prior to HSCT in 65 pediatric patients with AML without favorable cytogenetics who underwent HSCT. Fifteen of the 65 patients died: three of TRM and 12 of disease-related mortality. The 5-year OS and EFS were 78.0% and 72.0%, respectively, and the 5-year cumulative relapse and TRM rates were 26.9% and 5.1%, respectively. Survival rates were not influenced by cytogenetic group (intermediated vs. poor), donor type (related vs. unrelated), transplant type (myeloablative vs. reduced-intensity conditioning), or number of pretransplant chemotherapy cycles (≤3 vs. >3 cycles). The low TRM rate and encouraging outcomes suggest that HSCT may be a feasible treatment for pediatric patients with AML without favorable cytogenetics.

Retrospective analysis of children with high‐risk acute myeloid leukemia who underwent allogeneic hematopoietic stem cell transplantation following complete remission with initial induction chemotherapy in the AML‐05 clinical trial

“…Over 70% of children with HR AML who received allo‐HSCT immediately after obtaining CR1 survived. We observed that the cumulative incidence rates of NRM and aGVHD/cGVHD were also similar to those reported in previous studies . This further supports the safety of this technique despite the fact that 74% of grafts were from alternative donors.…”

Increased PD-1 expression of bone marrow T-cells in acute myeloid leukaemia patients after stem cell transplantation, and its association with overall survival

“…In the AML cases, the detailed informations about regimen for chemotherapeutic protocols and allogeneic haematopoietic cell transplantation used in our study are represented in the previous literatures. 14,15 The clinical and laboratory characteristics of these patients are summarized in Table 1.…”

Current treatment for pediatric acute myeloid leukemia

“…Remarkable improvements have been made in the field of HSCT in children and adolescents over the last decade because of the development of optimal conditioning regimens, more effective graft-versus-host disease (GVHD) prophylaxis, and advancements in post-transplant care. In an experienced transplant center, patients who received HSCT from a matched unrelated donor (URD) showed similar outcomes to those who received HSCT from a human leukocyte antigen (HLA)-matched sibling donor (MSD) [ 7 8 ]. Furthermore, the outcomes of HSCT even with an alternative donor, including transplants using umbilical cord blood or a haploidentical family donor, significantly improved [ 9 10 ].…”