Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia
Background Post‐transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Data on risk factors, treatment options, and outcomes are limited. Procedure In this retrospective multicenter study in which a questio...
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| Veröffentlicht in: | Pediatric transplantation 2021-08, Vol.25 (5), p.e13942-n/a |
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| creator | Hazar, Volkan Tezcan Karasu, Gülsün Öztürk, Gülyüz Küpesiz, Alphan Aksoylar, Serap Özbek, Namık Uygun, Vedat İleri, Talia Okur, Fatma Visal Koçak, Ülker Kılıç, Suar Çakı Akçay, Arzu Güler, Elif Kansoy, Savaş Karakükcü, Musa Bayram, İbrahim Aksu, Tekin Yeşilipek, Akif Karagün, Barbaros Şahin Yılmaz, Şebnem Ertem, Mehmet Uçkan, Duygu Fışgın, Tunç Gürsel, Orhan Yaman, Yöntem Bozkurt, Ceyhun Gökçe, Müge |
| description | Background
Post‐transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Data on risk factors, treatment options, and outcomes are limited.
Procedure
In this retrospective multicenter study in which a questionnaire was sent to all pediatric transplant centers reporting relapse after allo‐HSCT for a cohort of 938 children with acute leukemia, we analyzed 255 children with relapse of acute leukemia after their first allo‐HSCT.
Results
The median interval from transplantation to relapse was 180 days, and the median follow‐up from relapse to the last follow‐up was 1844 days. The 3‐year overall survival (OS) rate was 12.0%. The main cause of death was disease progression or subsequent relapse (82.6%). The majority of children received salvage treatment with curative intent without a second HSCT (67.8%), 22.0% of children underwent a second allo‐HSCT, and 10.2% received palliative therapy. Isolated extramedullary relapse (hazard ratio (HR): 0.607, P = .011) and relapse earlier than 365 days post‐transplantation (HR: 2.101, P |
| doi_str_mv | 10.1111/petr.13942 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2470629401</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2470629401</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3572-5cbd477f3b29666c42eafbc8a9c86a744267f092413cc05418949f20dbc120c23</originalsourceid><addsrcrecordid>eNp9kU1rFTEUhoMotlY3_gAJuCnC1HzNZLKUUj-gYJG6DpnMSW9qJhmTTEv3_nBn7q0uXHg271k85-HAi9BrSs7oOu9nqPmMciXYE3S8pmo4Ed3T_S4bTgU7Qi9KuSWEdqIXz9ER55wRpdpj9Osqp5uYSvUWO2NrygW7lHFZ8p2_MwH7iO3OhzFDxPe7hDMEMxcYsXEVMjYhpBuIsJ7vYDI1zcnDJisVJmwhBFyziWUOJlZTfYp7vbFLBRxg-QGTNy_RM2dCgVePeYK-f7y4Pv_cXH799OX8w2VjeStZ09phFFI6PjDVdZ0VDIwbbG-U7TsjhWCddEQxQbm1pBW0V0I5RsbBUkYs4yfo9OCdc_q5QKl68mX70URIS9FMSNIxJQhd0bf_oLdpyXH9TrO2balkst-odwfK5lRKBqfn7CeTHzQleutGb93ofTcr_OZRuQwTjH_RP2WsAD0A9z7Aw39U-uri-ttB-ht0mpvJ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2555172781</pqid></control><display><type>article</type><title>Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia</title><source>Access via Wiley Online Library</source><source>MEDLINE</source><creator>Hazar, Volkan ; Tezcan Karasu, Gülsün ; Öztürk, Gülyüz ; Küpesiz, Alphan ; Aksoylar, Serap ; Özbek, Namık ; Uygun, Vedat ; İleri, Talia ; Okur, Fatma Visal ; Koçak, Ülker ; Kılıç, Suar Çakı ; Akçay, Arzu ; Güler, Elif ; Kansoy, Savaş ; Karakükcü, Musa ; Bayram, İbrahim ; Aksu, Tekin ; Yeşilipek, Akif ; Karagün, Barbaros Şahin ; Yılmaz, Şebnem ; Ertem, Mehmet ; Uçkan, Duygu ; Fışgın, Tunç ; Gürsel, Orhan ; Yaman, Yöntem ; Bozkurt, Ceyhun ; Gökçe, Müge</creator><creatorcontrib>Hazar, Volkan ; Tezcan Karasu, Gülsün ; Öztürk, Gülyüz ; Küpesiz, Alphan ; Aksoylar, Serap ; Özbek, Namık ; Uygun, Vedat ; İleri, Talia ; Okur, Fatma Visal ; Koçak, Ülker ; Kılıç, Suar Çakı ; Akçay, Arzu ; Güler, Elif ; Kansoy, Savaş ; Karakükcü, Musa ; Bayram, İbrahim ; Aksu, Tekin ; Yeşilipek, Akif ; Karagün, Barbaros Şahin ; Yılmaz, Şebnem ; Ertem, Mehmet ; Uçkan, Duygu ; Fışgın, Tunç ; Gürsel, Orhan ; Yaman, Yöntem ; Bozkurt, Ceyhun ; Gökçe, Müge ; Turkish Pediatric Bone Marrow Transplantation Study Group ; the Turkish Pediatric Bone Marrow Transplantation Study Group</creatorcontrib><description>Background
Post‐transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Data on risk factors, treatment options, and outcomes are limited.
Procedure
In this retrospective multicenter study in which a questionnaire was sent to all pediatric transplant centers reporting relapse after allo‐HSCT for a cohort of 938 children with acute leukemia, we analyzed 255 children with relapse of acute leukemia after their first allo‐HSCT.
Results
The median interval from transplantation to relapse was 180 days, and the median follow‐up from relapse to the last follow‐up was 1844 days. The 3‐year overall survival (OS) rate was 12.0%. The main cause of death was disease progression or subsequent relapse (82.6%). The majority of children received salvage treatment with curative intent without a second HSCT (67.8%), 22.0% of children underwent a second allo‐HSCT, and 10.2% received palliative therapy. Isolated extramedullary relapse (hazard ratio (HR): 0.607, P = .011) and relapse earlier than 365 days post‐transplantation (HR: 2.101, P < .001 for 0‐180 days; HR: 1.522, P = .041 for 181‐365 days) were found in multivariate analysis to be significant prognostic factors for outcome. The type of salvage therapy in chemosensitive relapse was identified as a significant prognostic factor for OS.
Conclusion
A salvage approach with curative intent may be considered for patients with post‐transplant relapse, even if they relapse in the first year post‐transplantation. For sustainable remission, a second allo‐HSCT may be recommended for patients who achieve complete remission after reinduction treatment.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.13942</identifier><identifier>PMID: 33320995</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Acute Disease ; acute leukemia ; Adolescent ; Child ; Child, Preschool ; Children ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation - methods ; Hematopoietic stem cells ; Humans ; Infant ; Infant, Newborn ; Leukemia ; Leukemia - diagnosis ; Leukemia - mortality ; Leukemia - therapy ; Male ; Medical prognosis ; Multivariate analysis ; Patients ; post‐transplant relapse ; Prognosis ; Recurrence ; Remission ; Remission (Medicine) ; Retrospective Studies ; Risk factors ; Salvage Therapy ; Stem cell transplantation ; Survival Analysis ; Transplantation, Homologous ; treatment ; Turkey - epidemiology ; Young Adult</subject><ispartof>Pediatric transplantation, 2021-08, Vol.25 (5), p.e13942-n/a</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3572-5cbd477f3b29666c42eafbc8a9c86a744267f092413cc05418949f20dbc120c23</citedby><cites>FETCH-LOGICAL-c3572-5cbd477f3b29666c42eafbc8a9c86a744267f092413cc05418949f20dbc120c23</cites><orcidid>0000-0003-0841-1667 ; 0000-0003-3257-7798 ; 0000-0002-1407-2334 ; 0000-0002-4640-6159 ; 0000-0001-9268-8858 ; 0000-0002-7678-5524 ; 0000-0002-4514-8637</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpetr.13942$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpetr.13942$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33320995$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hazar, Volkan</creatorcontrib><creatorcontrib>Tezcan Karasu, Gülsün</creatorcontrib><creatorcontrib>Öztürk, Gülyüz</creatorcontrib><creatorcontrib>Küpesiz, Alphan</creatorcontrib><creatorcontrib>Aksoylar, Serap</creatorcontrib><creatorcontrib>Özbek, Namık</creatorcontrib><creatorcontrib>Uygun, Vedat</creatorcontrib><creatorcontrib>İleri, Talia</creatorcontrib><creatorcontrib>Okur, Fatma Visal</creatorcontrib><creatorcontrib>Koçak, Ülker</creatorcontrib><creatorcontrib>Kılıç, Suar Çakı</creatorcontrib><creatorcontrib>Akçay, Arzu</creatorcontrib><creatorcontrib>Güler, Elif</creatorcontrib><creatorcontrib>Kansoy, Savaş</creatorcontrib><creatorcontrib>Karakükcü, Musa</creatorcontrib><creatorcontrib>Bayram, İbrahim</creatorcontrib><creatorcontrib>Aksu, Tekin</creatorcontrib><creatorcontrib>Yeşilipek, Akif</creatorcontrib><creatorcontrib>Karagün, Barbaros Şahin</creatorcontrib><creatorcontrib>Yılmaz, Şebnem</creatorcontrib><creatorcontrib>Ertem, Mehmet</creatorcontrib><creatorcontrib>Uçkan, Duygu</creatorcontrib><creatorcontrib>Fışgın, Tunç</creatorcontrib><creatorcontrib>Gürsel, Orhan</creatorcontrib><creatorcontrib>Yaman, Yöntem</creatorcontrib><creatorcontrib>Bozkurt, Ceyhun</creatorcontrib><creatorcontrib>Gökçe, Müge</creatorcontrib><creatorcontrib>Turkish Pediatric Bone Marrow Transplantation Study Group</creatorcontrib><creatorcontrib>the Turkish Pediatric Bone Marrow Transplantation Study Group</creatorcontrib><title>Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>Background
Post‐transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Data on risk factors, treatment options, and outcomes are limited.
Procedure
In this retrospective multicenter study in which a questionnaire was sent to all pediatric transplant centers reporting relapse after allo‐HSCT for a cohort of 938 children with acute leukemia, we analyzed 255 children with relapse of acute leukemia after their first allo‐HSCT.
Results
The median interval from transplantation to relapse was 180 days, and the median follow‐up from relapse to the last follow‐up was 1844 days. The 3‐year overall survival (OS) rate was 12.0%. The main cause of death was disease progression or subsequent relapse (82.6%). The majority of children received salvage treatment with curative intent without a second HSCT (67.8%), 22.0% of children underwent a second allo‐HSCT, and 10.2% received palliative therapy. Isolated extramedullary relapse (hazard ratio (HR): 0.607, P = .011) and relapse earlier than 365 days post‐transplantation (HR: 2.101, P < .001 for 0‐180 days; HR: 1.522, P = .041 for 181‐365 days) were found in multivariate analysis to be significant prognostic factors for outcome. The type of salvage therapy in chemosensitive relapse was identified as a significant prognostic factor for OS.
Conclusion
A salvage approach with curative intent may be considered for patients with post‐transplant relapse, even if they relapse in the first year post‐transplantation. For sustainable remission, a second allo‐HSCT may be recommended for patients who achieve complete remission after reinduction treatment.</description><subject>Acute Disease</subject><subject>acute leukemia</subject><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Hematopoietic stem cells</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Leukemia</subject><subject>Leukemia - diagnosis</subject><subject>Leukemia - mortality</subject><subject>Leukemia - therapy</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>post‐transplant relapse</subject><subject>Prognosis</subject><subject>Recurrence</subject><subject>Remission</subject><subject>Remission (Medicine)</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Salvage Therapy</subject><subject>Stem cell transplantation</subject><subject>Survival Analysis</subject><subject>Transplantation, Homologous</subject><subject>treatment</subject><subject>Turkey - epidemiology</subject><subject>Young Adult</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1rFTEUhoMotlY3_gAJuCnC1HzNZLKUUj-gYJG6DpnMSW9qJhmTTEv3_nBn7q0uXHg271k85-HAi9BrSs7oOu9nqPmMciXYE3S8pmo4Ed3T_S4bTgU7Qi9KuSWEdqIXz9ER55wRpdpj9Osqp5uYSvUWO2NrygW7lHFZ8p2_MwH7iO3OhzFDxPe7hDMEMxcYsXEVMjYhpBuIsJ7vYDI1zcnDJisVJmwhBFyziWUOJlZTfYp7vbFLBRxg-QGTNy_RM2dCgVePeYK-f7y4Pv_cXH799OX8w2VjeStZ09phFFI6PjDVdZ0VDIwbbG-U7TsjhWCddEQxQbm1pBW0V0I5RsbBUkYs4yfo9OCdc_q5QKl68mX70URIS9FMSNIxJQhd0bf_oLdpyXH9TrO2balkst-odwfK5lRKBqfn7CeTHzQleutGb93ofTcr_OZRuQwTjH_RP2WsAD0A9z7Aw39U-uri-ttB-ht0mpvJ</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>Hazar, Volkan</creator><creator>Tezcan Karasu, Gülsün</creator><creator>Öztürk, Gülyüz</creator><creator>Küpesiz, Alphan</creator><creator>Aksoylar, Serap</creator><creator>Özbek, Namık</creator><creator>Uygun, Vedat</creator><creator>İleri, Talia</creator><creator>Okur, Fatma Visal</creator><creator>Koçak, Ülker</creator><creator>Kılıç, Suar Çakı</creator><creator>Akçay, Arzu</creator><creator>Güler, Elif</creator><creator>Kansoy, Savaş</creator><creator>Karakükcü, Musa</creator><creator>Bayram, İbrahim</creator><creator>Aksu, Tekin</creator><creator>Yeşilipek, Akif</creator><creator>Karagün, Barbaros Şahin</creator><creator>Yılmaz, Şebnem</creator><creator>Ertem, Mehmet</creator><creator>Uçkan, Duygu</creator><creator>Fışgın, Tunç</creator><creator>Gürsel, Orhan</creator><creator>Yaman, Yöntem</creator><creator>Bozkurt, Ceyhun</creator><creator>Gökçe, Müge</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0841-1667</orcidid><orcidid>https://orcid.org/0000-0003-3257-7798</orcidid><orcidid>https://orcid.org/0000-0002-1407-2334</orcidid><orcidid>https://orcid.org/0000-0002-4640-6159</orcidid><orcidid>https://orcid.org/0000-0001-9268-8858</orcidid><orcidid>https://orcid.org/0000-0002-7678-5524</orcidid><orcidid>https://orcid.org/0000-0002-4514-8637</orcidid></search><sort><creationdate>202108</creationdate><title>Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia</title><author>Hazar, Volkan ; Tezcan Karasu, Gülsün ; Öztürk, Gülyüz ; Küpesiz, Alphan ; Aksoylar, Serap ; Özbek, Namık ; Uygun, Vedat ; İleri, Talia ; Okur, Fatma Visal ; Koçak, Ülker ; Kılıç, Suar Çakı ; Akçay, Arzu ; Güler, Elif ; Kansoy, Savaş ; Karakükcü, Musa ; Bayram, İbrahim ; Aksu, Tekin ; Yeşilipek, Akif ; Karagün, Barbaros Şahin ; Yılmaz, Şebnem ; Ertem, Mehmet ; Uçkan, Duygu ; Fışgın, Tunç ; Gürsel, Orhan ; Yaman, Yöntem ; Bozkurt, Ceyhun ; Gökçe, Müge</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3572-5cbd477f3b29666c42eafbc8a9c86a744267f092413cc05418949f20dbc120c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute Disease</topic><topic>acute leukemia</topic><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematopoietic Stem Cell Transplantation - methods</topic><topic>Hematopoietic stem cells</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Leukemia</topic><topic>Leukemia - diagnosis</topic><topic>Leukemia - mortality</topic><topic>Leukemia - therapy</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Multivariate analysis</topic><topic>Patients</topic><topic>post‐transplant relapse</topic><topic>Prognosis</topic><topic>Recurrence</topic><topic>Remission</topic><topic>Remission (Medicine)</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Salvage Therapy</topic><topic>Stem cell transplantation</topic><topic>Survival Analysis</topic><topic>Transplantation, Homologous</topic><topic>treatment</topic><topic>Turkey - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hazar, Volkan</creatorcontrib><creatorcontrib>Tezcan Karasu, Gülsün</creatorcontrib><creatorcontrib>Öztürk, Gülyüz</creatorcontrib><creatorcontrib>Küpesiz, Alphan</creatorcontrib><creatorcontrib>Aksoylar, Serap</creatorcontrib><creatorcontrib>Özbek, Namık</creatorcontrib><creatorcontrib>Uygun, Vedat</creatorcontrib><creatorcontrib>İleri, Talia</creatorcontrib><creatorcontrib>Okur, Fatma Visal</creatorcontrib><creatorcontrib>Koçak, Ülker</creatorcontrib><creatorcontrib>Kılıç, Suar Çakı</creatorcontrib><creatorcontrib>Akçay, Arzu</creatorcontrib><creatorcontrib>Güler, Elif</creatorcontrib><creatorcontrib>Kansoy, Savaş</creatorcontrib><creatorcontrib>Karakükcü, Musa</creatorcontrib><creatorcontrib>Bayram, İbrahim</creatorcontrib><creatorcontrib>Aksu, Tekin</creatorcontrib><creatorcontrib>Yeşilipek, Akif</creatorcontrib><creatorcontrib>Karagün, Barbaros Şahin</creatorcontrib><creatorcontrib>Yılmaz, Şebnem</creatorcontrib><creatorcontrib>Ertem, Mehmet</creatorcontrib><creatorcontrib>Uçkan, Duygu</creatorcontrib><creatorcontrib>Fışgın, Tunç</creatorcontrib><creatorcontrib>Gürsel, Orhan</creatorcontrib><creatorcontrib>Yaman, Yöntem</creatorcontrib><creatorcontrib>Bozkurt, Ceyhun</creatorcontrib><creatorcontrib>Gökçe, Müge</creatorcontrib><creatorcontrib>Turkish Pediatric Bone Marrow Transplantation Study Group</creatorcontrib><creatorcontrib>the Turkish Pediatric Bone Marrow Transplantation Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hazar, Volkan</au><au>Tezcan Karasu, Gülsün</au><au>Öztürk, Gülyüz</au><au>Küpesiz, Alphan</au><au>Aksoylar, Serap</au><au>Özbek, Namık</au><au>Uygun, Vedat</au><au>İleri, Talia</au><au>Okur, Fatma Visal</au><au>Koçak, Ülker</au><au>Kılıç, Suar Çakı</au><au>Akçay, Arzu</au><au>Güler, Elif</au><au>Kansoy, Savaş</au><au>Karakükcü, Musa</au><au>Bayram, İbrahim</au><au>Aksu, Tekin</au><au>Yeşilipek, Akif</au><au>Karagün, Barbaros Şahin</au><au>Yılmaz, Şebnem</au><au>Ertem, Mehmet</au><au>Uçkan, Duygu</au><au>Fışgın, Tunç</au><au>Gürsel, Orhan</au><au>Yaman, Yöntem</au><au>Bozkurt, Ceyhun</au><au>Gökçe, Müge</au><aucorp>Turkish Pediatric Bone Marrow Transplantation Study Group</aucorp><aucorp>the Turkish Pediatric Bone Marrow Transplantation Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2021-08</date><risdate>2021</risdate><volume>25</volume><issue>5</issue><spage>e13942</spage><epage>n/a</epage><pages>e13942-n/a</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><abstract>Background
Post‐transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Data on risk factors, treatment options, and outcomes are limited.
Procedure
In this retrospective multicenter study in which a questionnaire was sent to all pediatric transplant centers reporting relapse after allo‐HSCT for a cohort of 938 children with acute leukemia, we analyzed 255 children with relapse of acute leukemia after their first allo‐HSCT.
Results
The median interval from transplantation to relapse was 180 days, and the median follow‐up from relapse to the last follow‐up was 1844 days. The 3‐year overall survival (OS) rate was 12.0%. The main cause of death was disease progression or subsequent relapse (82.6%). The majority of children received salvage treatment with curative intent without a second HSCT (67.8%), 22.0% of children underwent a second allo‐HSCT, and 10.2% received palliative therapy. Isolated extramedullary relapse (hazard ratio (HR): 0.607, P = .011) and relapse earlier than 365 days post‐transplantation (HR: 2.101, P < .001 for 0‐180 days; HR: 1.522, P = .041 for 181‐365 days) were found in multivariate analysis to be significant prognostic factors for outcome. The type of salvage therapy in chemosensitive relapse was identified as a significant prognostic factor for OS.
Conclusion
A salvage approach with curative intent may be considered for patients with post‐transplant relapse, even if they relapse in the first year post‐transplantation. For sustainable remission, a second allo‐HSCT may be recommended for patients who achieve complete remission after reinduction treatment.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33320995</pmid><doi>10.1111/petr.13942</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0841-1667</orcidid><orcidid>https://orcid.org/0000-0003-3257-7798</orcidid><orcidid>https://orcid.org/0000-0002-1407-2334</orcidid><orcidid>https://orcid.org/0000-0002-4640-6159</orcidid><orcidid>https://orcid.org/0000-0001-9268-8858</orcidid><orcidid>https://orcid.org/0000-0002-7678-5524</orcidid><orcidid>https://orcid.org/0000-0002-4514-8637</orcidid></addata></record> |
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| ispartof | Pediatric transplantation, 2021-08, Vol.25 (5), p.e13942-n/a |
| issn | 1397-3142 1399-3046 |
| language | eng |
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| source | Access via Wiley Online Library; MEDLINE |
| subjects | Acute Disease acute leukemia Adolescent Child Child, Preschool Children Combined Modality Therapy Female Follow-Up Studies Hematopoietic Stem Cell Transplantation - methods Hematopoietic stem cells Humans Infant Infant, Newborn Leukemia Leukemia - diagnosis Leukemia - mortality Leukemia - therapy Male Medical prognosis Multivariate analysis Patients post‐transplant relapse Prognosis Recurrence Remission Remission (Medicine) Retrospective Studies Risk factors Salvage Therapy Stem cell transplantation Survival Analysis Transplantation, Homologous treatment Turkey - epidemiology Young Adult |
| title | Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T21%3A32%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prognostic%20factors%20for%20survival%20in%20children%20who%20relapsed%20after%20allogeneic%20hematopoietic%20stem%20cell%20transplantation%20for%20acute%20leukemia&rft.jtitle=Pediatric%20transplantation&rft.au=Hazar,%20Volkan&rft.aucorp=Turkish%20Pediatric%20Bone%20Marrow%20Transplantation%20Study%20Group&rft.date=2021-08&rft.volume=25&rft.issue=5&rft.spage=e13942&rft.epage=n/a&rft.pages=e13942-n/a&rft.issn=1397-3142&rft.eissn=1399-3046&rft_id=info:doi/10.1111/petr.13942&rft_dat=%3Cproquest_cross%3E2470629401%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2555172781&rft_id=info:pmid/33320995&rfr_iscdi=true |