Allogeneic hematopoietic stem cell transplant in pediatric acute myeloid leukemia: Lessons learnt from a tertiary care center in India

Abstract

The outcomes in pediatric AML have improved consistently over the past three decades, with 5-year EFS rates of 49%-63% and 5-year OS rates of 60%-75%. 1 allo-HSCT is the most effective treatment strategy currently available for children with relapsed or high-risk AML. This curative potential of allo-HSCT is based upon the combination of cytoreduction from conditioning chemotherapy and robust

Hematopoietic Stem Cell Transplant for Hematological Malignancies: Experience from a Tertiary Care Center in Northern India and Review of Indian Data

“… 14 15 Among children (age ≤ 18 years) with AML who underwent allogeneic HSCT, Arora et al have reported 5-year OS and EFS of 36.3 and 33.3%, respectively. 16 …”

“…14,15 Among children (age ≤ 18 years) with AML who underwent allogeneic HSCT, Arora et al have reported 5-year OS and EFS of 36.3 and 33.3%, respectively. 16 In allogeneic HSCTs, matched donor HSCTs are still preferred over HID-HSCTs; however, advances in graft techniques and pharmacological prophylaxis of GVHD have reduced the risks of graft failure and GVHD after HID-HSCT and have made haploidentical stem cell source a viable alternative for patients lacking an human leukocyte antigen-matched donor. 17 There are no published randomized comparisons of HID HSCT versus MSD HSCT.…”

Decoding mitochondrial genes in pediatric AML and development of a novel prognostic mitochondrial gene signature

“…Conventional cytogenetics were done at baseline to identify translocations, inversions, deletion as well as other chromosomal abnormalities for risk stratification of pediatric AML. Mutation profiling of RUNX1-RUNX1T1 (Runt-related transcription factor 1-RUNX1 partner transcriptional co-repressor 1 fusion transcript), CBFB-MYH11 (Core binding factor beta-myosin heavy chain 11 fusion transcript), FLT3-ITD (Fms like tyrosine kinase 3-internal tandem duplication), and NPM1 (Nucleophosmin 1) by reverse transcriptase polymerase chain reaction (PCR) were performed at baseline for risk assessment as per European LeukemiaNet (ELN) recommendation (13).…”

“…Consolidation therapy with three cycles of high dose cytarabine at 18g/m 2 were given to patients after achieving complete remission (CR) whereas repeated induction with ADE regimen (cytarabine: 100 mg/m2 twice daily, day 1-10; daunorubicin: 50 mg/m2, day 1-3; and etoposide: 100 mg/m2, day 1-5) were used for refractory or relapse cases. Patients at CR2 underwent allogeneic hematopoietic stem cell transplantation with matched sibling donor if available (13, 14).…”

Autologous Hematopoietic Stem Cell Transplant: A Potential Option for Relapsed Pediatric Acute Myeloid Leukemia With Lack of Matched Sibling Donor and Resource Challenge

“…In the current cohort of children with relapsed AML, the relapse rate of 46% and 38% deaths are almost similar to data reported by Webb et al 6 where they showed 32% relapse and 41% deaths in children who underwent autologous HSCT in CR2. In our recently published data on allogeneic HSCT in children with AML (which predominantly consisted of subjects with relapsed disease), the 5-year EFS was 33.3 ± 7.2% and OS was 36.3 ± 7.6% 16 ; CR1 duration <12 months was associated with poorer survival. Although CR1 duration did not emerge as a significant predictor of survival in the current study, it is to be noted that only 20% of this cohort had a CR duration of <12 months.…”