Treatment of Children with Relapsed Acute Lymphoblastic Leukemia Studies of the BFM Study Group

Adams, HP; Henze, Günter

doi:10.1007/978-3-642-71960-8_98

Cited by 1 publication

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“…However, less than 5% of the patients with an early relapse (during therapy or within 30 months of diagnosis) and 25-40% of those with a late relapse (after 6 months of completion of therapy or as of 30 months since diagnosis) are long-term survivors. [5][6][7] Allogeneic haemopoietic cell transplantation (allo-HCT) from a matched sibling donor has been shown to be superior to chemotherapy, especially for patients with an early relapse; [8][9][10][11][12][13] for late isolated extramedullary relapse, chemotherapy alone may play a role. 14,15 However, the lack of a compatible matched sibling donor limits the use of this treatment.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of allogeneic or autologous haemopoietic cell transplantation for acute lymphoblastic leukaemia in second remission in children. GETMON experience 1983–1998

Badell

Muñoz

Ortega

et al. 2005

Bone Marrow Transplant

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Summary:We present a retrospective study of long-term outcome and predictive factors of survival and relapse in 219 paediatric patients with acute lymphoblastic leukaemia (ALL) in second remission. They received allogeneic (allo) or autologous (auto) haemopoietic cell transplantation (HCT) depending on the availability of a matched sibling donor. The probability of event-free survival (EFS) for the total patient group was 0.35 þ 0.03 at 14 years. No significant differences were observed for EFS between allo-and auto-HCT: 0.39 þ 0.05 vs 0.32 þ 0.04 (P ¼ 0.43). A better EFS was seen in patients with a late relapse (LR) (P ¼ 0.06 and 0.02, for allogeneic and autologous respectively). Significantly better EFS was observed in allo-HCT patients under 10 years of age and in auto-HCT patients with leukocytes at diagnosis below 25 Â 109/l and late relapse. Predictive factors of failure in both groups were early relapse (ER), medullary relapse and age over 10 years. The probability of relapse (RP) for the total group of patients was 0.57 þ 0.03, and it was significantly higher in auto-HCT patients: 0.65 þ 0.04 vs 0.42 þ 0.06 (P ¼ 0.002). Factors predictive for relapse were medullary and early relapse, auto-HCT and WBC 425 Â 109/l at diagnosis. The intensive chemotherapy regimen presently used for childhood lymphoblastic leukaemia allows a prolonged disease-free survival in more than 70% of patients. 1 Relapse is observed in approximately 20-25% of patients, mostly within the first 5 years after diagnosis. 2,3 Optimal therapy for relapsed patients remains controversial in some areas. 4 With the use of intensive chemotherapy, 80-95% of patients achieved a complete second remission. However, less than 5% of the patients with an early relapse (during therapy or within 30 months of diagnosis) and 25-40% of those with a late relapse (after 6 months of completion of therapy or as of 30 months since diagnosis) are long-term survivors. 5-7 Allogeneic haemopoietic cell transplantation (allo-HCT) from a matched sibling donor has been shown to be superior to chemotherapy, especially for patients with an early relapse; 8-13 for late isolated extramedullary relapse, chemotherapy alone may play a role. 14,15 However, the lack of a compatible matched sibling donor limits the use of this treatment. The safety and efficacy of autologous HCT (auto-HCT) in children with acute lymphoblastic leukaemia (ALL) has been previously reported. [16][17][18][19][20][21][22] Comparison studies of auto-and allo-HCT have suggested different failure patterns, but comparable survival rates. Auto-HCT offers the advantages of an accelerated immunological recovery and the absence of graft-versus-host disease (GVHD) compared with allo-HCT. By contrast, a higher relapse rate is observed in patients receiving an autologous transplant. [23][24] However, the heterogeneity of populations used for comparison (stage of disease, risk factors, prior therapy, conditioning regimens) makes it difficult to reach any conclusions which may be useful in therapeutic decision-ma...

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