Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research

Eapen, Mary; Raetz, Elizabeth A.; Zhang, Mei‐Jie; Muehlenbein, Catherine; Devidas, Meenakshi; Abshire, Thomas C.; Billett, Amy L.; Homans, Alan C.; Camitta, Bruce M.; Carroll, William L.; Davies, Stella M.

doi:10.1182/blood-2005-12-4942

Cited by 150 publications

(106 citation statements)

References 25 publications

(33 reference statements)

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“…[1][2][3][4][5][6][7][8][9] However, the treatment is still controversial for low-risk relapses, which either involve extramedullary sites only and/or occur late in the BM. [10][11][12][13][14] Autologous transplantation may be an alternative to chemotherapy for ALL in CR2 after low-risk relapse.…”

Section: Introductionmentioning

confidence: 99%

Autologous purified peripheral blood SCT in childhood low-risk relapsed ALL

Balduzzi

Bonanomi

Valsecchi

et al. 2010

Bone Marrow Transplant

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The treatment of childhood B-cell-precursor ALL after isolated-extramedullary or late relapse is controversial. Most approaches are based on chemotherapy or allogeneic transplantation. The aim of this report is to assess the long-term outcome of children with 'low-risk' relapsed ALL treated according to a prospective purified autotransplantation protocol. From January 1997 to March 2004, at a single pediatric Center, 30 ALL consecutive children, lacking an HLA-identical sibling, were treated according to the autologous purified peripheral blood stem cell protocol after isolated-extramedullary (7) or late medullary (24) relapse. After the 'DIAVE' mobilizing regimen a median of 11.6 Â 10 6 CD34 þ /Kg (range 3.9-27.4) were collected. Leukaphereses were depleted by 99% of CD19 þ cells (range 98-100) by means of a double step immunological purification. The conditioning regimen included TBI. No early severe complications nor transplant-related deaths occurred; late effects, as expected, mostly consisted in endocrinological issues and were assessed at a median follow-up of 8.5 years. Five-year-EFS and survival were 68.5% (s.e. 7.9) and 85.7% (s.e. 5.9), respectively, for the 35 eligible patients and 70.0% (s.e. 8.4) and 86.7% (s.e. 6.2) for the 30 patients actually transplanted as per protocol. The outcome of this series favorably compares with historical data regarding both autologous transplantation and standard salvage chemotherapy.

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Section: Introductionmentioning

confidence: 99%

Autologous purified peripheral blood SCT in childhood low-risk relapsed ALL

Balduzzi

Bonanomi

Valsecchi

et al. 2010

Bone Marrow Transplant

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“…This differs from results observed after bone marrow relapse, where improved disease control can be achieved with transplantation when relapse occurs early. 8,14 In the absence of a graft-versusleukemia effect in the CNS and higher rates of treatment-related deaths after transplantation, transplantation does not offer an additional advantage over an intensified chemotherapeutic approach with irradiation. As reported previously, among transplant recipients, TBI-based regimens play a critical role in preventing a subsequent leukemia relapse in ALL.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after HLA-matched sibling transplantation or chemotherapy in children with acute lymphoblastic leukemia in a second remission after an isolated central nervous system relapse: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research

et al. 2007

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In children with acute lymphoblastic leukemia (ALL) with isolated central nervous system (CNS) relapse and a human leucocyte antigen (HLA)-matched sibling, the optimal treatment after attaining second remission is unknown. We compared outcomes in 149 patients enrolled on chemotherapy trials and 60 HLA-matched sibling transplants, treated in 1990-2000. All patients achieved a second complete remission. Groups were similar, except the chemotherapy recipients were younger at diagnosis, less likely to have T-cell ALL and had longer duration (X18 months) first remission. To adjust for time-totransplant bias, left-truncated Cox's regression models were constructed. Relapse rates were similar after chemotherapy and transplantation. In both treatment groups, relapse rates were higher in older children (11-17 years; RR 2.81, P ¼ 0.002) and shorter first remission (o18 months; RR 3.89, Po0.001). Treatment-related mortality rates were higher after transplantation (RR 4.28, P ¼ 0.001). The 8-year probabilities of leukemiafree survival adjusted for age and duration of first remission were similar after chemotherapy with irradiation and transplantation (66 and 58%, respectively). In the absence of an advantage for one treatment option over another, the data support use of either intensive chemotherapy with irradiation or HLA-matched sibling transplantation with total body irradiation containing conditioning regimen for children with ALL in second remission after an isolated CNS relapse.

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“…[8][9][10][11][12] Yet, the use of fTBI in conjunction with CY also continues. 13 The clinical efficacy of chemotherapy-only regimens over fTBI-containing regimens in the conditioning of patients with ALL and over the age of 2 years has not been established. 7 For patients above the age of 2-3 years but not eligible for fTBI (for example, those with a history of high-dose irradiation), chemotherapy-only regimens (for example, BU/CY/melphalan (Mel)) are employed.…”

Section: Acute Lymphoblastic Leukemiamentioning

confidence: 99%

Current European practice in pediatric myeloablative conditioning

Vettenranta

2008

Bone Marrow Transplant

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Myeloablative conditioning continues to be employed in hematopoietic stem cell transplantation among patients with pediatric transplant indications. Fractionated TBI (fTBI) remains, with its considerable anti-leukemic potential, the cornerstone of conditioning in the most common of pediatric indications, ALL in its first, second or subsequent remission despite its well-established longterm sequelae. The feasibility of chemotherapy-only regimens has been established and these regimens widely employed in other pediatric indications, for example, in ALL below the age of 2 years, AML, myelodysplasias or severe aplastic anemia. Conditioning regimens are being modified with data accumulating on the role of, for example, pre-transplant residual disease, advanced HLAtyping or haploidentical transplantations in the pediatric setting.

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Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research

Cited by 150 publications

References 25 publications

Autologous purified peripheral blood SCT in childhood low-risk relapsed ALL

Autologous purified peripheral blood SCT in childhood low-risk relapsed ALL

Current European practice in pediatric myeloablative conditioning

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