Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children

Abstract

Relapse of acute lymphoblastic leukemia (ALL) may occur in extramedullary sites, mainly central nervous system (CNS) and testis. Optimal post-remissional treatment for isolated extramedullary relapse (IEMR) is still controversial. We collected data of children treated with hematopoietic stem cell transplantation (HSCT) for ALL IEMR from 1990 to 2015 in Italy. Among 281 patients, 167 had a relapse confined to CNS, 73 to testis, 14 to mediastinum, and 27 to other organs. Ninety-seven patients underwent autologous HSCT, 79 received allogeneic HSCT from a matched family donor, 75 from a matched unrelated donor, and 30 from an HLA-haploidentical donor. The 10-year overall survival was 56% and was not influenced by gender, ALL blast immune-phenotype, age, site of relapse, duration of first remission, and type of HSCT. In multivariable analysis, the only prognostic factors were disease status at HSCT and year of transplantation. Patients transplanted in third or subsequent complete remission (CR) had a risk of death 2.3 times greater than those in CR2. Children treated after 2000 had half the risk of death than those treated before that year. Our results suggest that both autologous and allogeneic HSCT may be considered for the treatment of pediatric ALL IEMR after the achievement of CR2.

Role of Autophagy and Apoptosis in Acute Lymphoblastic Leukemia

“…About 15-20% of childhood ALL patients relapse. 16 Therefore, how to effectively detect minimal residual disease (MRD) is important for the prognosis of ALL. MRD is assessed through the examination of remission bone marrow samples.…”

The Effects Of Stem Cell Therapy In The Treatment Of Childhood Acute Lymphoblastic Leukemia

“…In human trials, CD16+ Natural Killer cells (NK) from cord blood stem cells have been used in cancer therapy by using an anti-CD47 antibody. This antibody triggers an antitumor response [34]. With ALL showing a higher level of CD47, the cord blood stem cells eradicated the ALL cells by using this antibody.…”

Testicular disposition of clofarabine in rats is dependent on equilibrative nucleoside transporters

“… 2 However, there are ALL patients who do not respond to chemotherapy or have a cancer recurrence after treatment, with the most common relapses occurring in the bone marrow, central nervous system, or gonads. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Acute myeloid leukemia (AML) is a common cancer among adults, with a much lower 5‐year survival rate of 29%. 11 , 12 , 13 Sanctuary sites such as the central nervous system or gonads may provide a location where the cancer can evade first‐line treatments.…”

“… 11 , 12 , 13 Sanctuary sites such as the central nervous system or gonads may provide a location where the cancer can evade first‐line treatments. 3 , 4 , 5 , 6 , 7 , 9 Testicular relapse of ALL or AML may require orchiectomy (complete removal of one or both testes) or irradiation, leaving the patient with reduced fertility or irreversible infertility, 8 which can have a devastating quality of life impact. The testis is an immune privileged site, which prevents autoimmunity against germ cells, but impedes the immune system response to cancer present within the testis.…”

“…Improved treatment of ALL has increased the 5‐year survival rate to 82% 2 . However, there are ALL patients who do not respond to chemotherapy or have a cancer recurrence after treatment, with the most common relapses occurring in the bone marrow, central nervous system, or gonads 3–10 . Acute myeloid leukemia (AML) is a common cancer among adults, with a much lower 5‐year survival rate of 29% 11–13 .…”