NYMC Faculty Publications

Transplant Outcomes for Children With T Cell Acute Lymphoblastic Leukemia in Second Remission: A Report from the Center for International Blood and Marrow Transplant Research

Author Type(s)

Faculty

DOI

10.1016/j.bbmt.2015.08.023

Journal Title

Biology of Blood and Marrow Transplantation

First Page

2154

Last Page

2159

Document Type

Article

Publication Date

12-1-2015

Department

Pediatrics

Keywords

Academic Medical Centers, Acute Disease, Adolescent, Bone Marrow Transplantation, Child, Child, Preschool, Chronic Disease, Female, Graft vs Host Disease, Humans, Immunosuppressive Agents, International Cooperation, Male, Myeloablative Agonists, Precursor T-Cell Lymphoblastic Leukemia-Lymphoma, Prospective Studies, Recurrence, Remission Induction, Severity of Illness Index, Survival Analysis, Transplantation Conditioning, Transplantation, Homologous, Treatment Outcome

Disciplines

Medicine and Health Sciences

Abstract

Survival for children with relapsed T cell acute lymphoblastic leukemia (T-ALL) is poor when treated with chemotherapy alone, and outcomes after allogeneic hematopoietic cell transplantation (HCT) is not well described. Two hundred twenty-nine children with T-ALL in second complete remission (CR2) received an HCT after myeloablative conditioning between 2000 and 2011 and were reported to the Center for International Blood and Marrow Transplant Research. Median age was 10 years (range, 2 to 18). Donor source was umbilical cord blood (26%), matched sibling bone marrow (38%), or unrelated bone marrow/peripheral blood (36%). Acute (grades II to IV) and chronic graft-versus-host disease occurred in, respectively, 35% (95% confidence interval [CI], 27% to 45%) and 26% (95% CI, 20% to 33%) of patients. Transplant-related mortality at day 100 and 3-year relapse rates were 13% (95% CI, 9% to 18%) and 30% (95% CI, 24% to 37%), respectively. Three-year overall survival and disease-free survival rates were 48% (95% CI, 41% to 55%) and 46% (95% CI, 39% to 52%), respectively. In multivariate analysis, patients with bone marrow relapse, with or without concurrent extramedullary relapse before HCT, were most likely to relapse (hazard ratio, 3.94; P = .005) as compared with isolated extramedullary disease. In conclusion, HCT for pediatric T-ALL in CR2 demonstrates reasonable and durable outcomes, and consideration for HCT is warranted.

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