Transplantation for AML in Children

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

“… 16‐18 . However, non‐relapse mortality (toxic death and sepsis‐related mortality) of 2.2% is in fact comparable to the western literature, wherein it ranges between 6% and 16% 19,20 …”

“…The 5-year OS was 36% in our cohort, which is inferior to the published OS ranging from 46 to 62 percent.. [16][17][18] However, non-relapse mortality (toxic death and sepsis-related mortality) of 2.2% is in fact comparable to the western literature, wherein it ranges between 6% and 16%. 19,20 The possible causes of relatively inferior outcomes of pediatric AML in India are differences in disease biology, high rates of early death (both due to toxicity and sepsis) and relapse, resource constraints, and limited access to HSCT. 21,22 Since in this study non-relapse mortality was similar to published literature and transplant was done in a government funded institution, we hypothesize that rather than resource limitation and TRM, differences in disease biology, and the lack of disease assessment at a molecular level (for presence of MRD or newly acquired mutations) to refine the selection of transplant candidates might be the factors accounting for poor post-HSCT outcome.…”

Predictors of early death and survival among children, adolescents and young adults with acute myeloid leukaemia in California, 1988–2011: a population‐based study

“…Although improvements in HSCT have led to a significant decrease in transplant-related morbidity and mortality in patients with AML (Ferrara and Schiffer 2013), the role of HSCT remains controversial. With the progress in the use of chemotherapy and the improvement in risk assessment over the last 25 years, HSCT in first remission is not recommended for AML patients that have a favourable prognosis (CBF AML) (Carpenter, et al 2012), and the use of HSCT may be limited to intermediate-risk patients who experience relapse after undergoing initial therapy (Burnett, et al 2013). …”

“…1Á0 (reference) 1Á0 (reference) 1Á0 (reference) 1Á0 (reference) Initial care at hospitals affiliated with NCI-designated cancer centres Yes (Ferrara & Schiffer, 2013), the role of HSCT remains controversial. With the progress in the use of chemotherapy and the improvement in risk assessment over the last 25 years, HSCT in first remission is not recommended for AML patients that have a favourable prognosis (CBF AML) (Carpenter et al, 2012), and the use of HSCT may be limited to intermediate-risk patients who experience relapse after undergoing initial therapy (Burnett et al, 2013). Because AML is a complex disease characterized by morphological and cytogenetic heterogeneity, we believe that multiple factors may have contributed to the lower survival we observed among older patients and those of black race/ ethnicity.…”

Comparison of a fludarabine and melphalan combination‐based reduced toxicity conditioning with myeloablative conditioning by radiation and/or busulfan in acute myeloid leukemia in Japanese children and adolescents

“…In adult recipients with AML or MDS with non‐advanced disease, intermediate intensity conditioning regimens ( e.g ., Flu and Mel, 80–140 mg/m 2 ) have nearly identical short‐ and long‐term disease progression compared with the MAC regimens . As the incidence of NRM after MAC is often lower in pediatric patients than it is in adults , the effect of RTC of lowering the rate of NRM would be predicted to have less impact on the pediatric OS rates. Therefore, retaining the myeloablative intensity is more important factor than reducing the short‐term comorbidity for its successful outcomes in pediatric patients who can tolerate standard MAC.…”