Transplant‐related mortality following allogeneic hematopoeitic stem cell transplantation for pediatric acute lymphoblastic leukemia: 25‐year retrospective review

Abstract

BackgroundOver the last 25 years, donor source, conditioning, graft-versus-host disease prevention and supportive care for children undergoing hematopoeitic stem cell transplantation (HSCT) have changed dramatically. HSCT indications for acute lymphoblastic leukemia (ALL) now include high-risk patients in first and subsequent remission. There is a large burden of infectious and pre-HSCT morbidities, due to myelosuppressive therapy required for remission induction. We hypothesized that, despite these trends, overall survival (OS) had increased.ProcedureA retrospective audit of allogeneic pediatric HSCT for ALL was performed in our institution over 25 years. Outcomes for 136 HSCTs were analyzed in three consecutive 8-year periods (Period 1: 1/1/1984–31/8/1992, Period 2: 1/9/1992–30/4/2001, Period 3: 1/5/2001–31/12/2009).ResultsDespite a significant increase in unrelated donor HSCT, event-free and OS over 25 years improved significantly. (EFS 31.6–64.8%, P = 0.0027; OS 41.8–78.9%, P < 0.0001) Concurrently, TRM dropped from 33% to 5% (P = 0.0004) whilst relapse rate was static (P = 0.07). TRM reduced significantly for matched sibling and unrelated cord blood transplantation (UCT) in Period 3 compared with earlier periods (P = 0.036, P = 0.0098, respectively). Factors leading to improved survival in patients undergoing UCT include better matching, higher total nucleated cell doses, and significantly faster neutrophil engraftment. Length of initial HSCT admission was similar over time.ConclusionEFS and OS have increased significantly despite heightened HSCT complexity. This survival gain was due to TRM reduction. Contemporary patients have benefited from refined donor selection and improved supportive care. Overall rates of leukemic relapse post-HSCT are unchanged, and remain the focus for improvement.

Improvement of overall survival after allogeneic hematopoietic stem cell transplantation for children and adolescents: a three-decade experience of a single institution

“…These results are in accordance with Mateos et al 42 who found a survival gain (OS and event-free survival) due to TRM reduction in allo-SCT for pediatric ALL. Focusing on the risk status disease, 5-year OS and 5-year PFS were significantly improved in the HR group between 1983 and 1999 period and 2000 and 2010, but this was not observed in the SR group.…”

“…These data are in agreement with previous studies. 38,42 Relapse remained the major cause of death post allo-SCT. Therefore, therapeutic advances are needed for both a better control of the pre-transplant disease and an improved post-transplant management.…”

Validación del índice de comorbilidad para trasplante hematopoyético en una cohorte retrospectiva de niños y adolescentes argentinos receptores de trasplante alogénico

“…Esto coincide con estudios previos sobre la MRT. 23 La literatura aporta datos que ayudan a entender la relación entre la comorbilidad previa al TH y estos eventos. Sorror y cols., reportaron, en un estudio multicéntrico reciente, una asociación entre el ICTH y el riesgo de formas más graves de EICH, 24 lo que coincide con la tendencia observada en nuestra muestra.…”

Validation of the Hematopoietic Cell Transplantation- Specific Comorbidity Index in a retrospective cohort of children and adolescents who received an allogeneic transplantation in Argentina

“…This is consistent with previous studies on TRM. 23 Data obtained from the literature are useful to understand the relationship between pre-HCT comorbidities and these events. Sorror et al reported, in a recent multicenter study, an association between HCT-CI and the risk for more severe forms of GvHD, 24 consistent with the trend observed in our sample.…”