| Autor: |
Dalle JH; Department of Pediatric Hemato-Immunology, Hôpital Robert Debré, APHP Nord-Université de Paris, Paris, France. jean-hugues.dalle@aphp.fr., Balduzzi A; Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy., Bader P; Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany., Pieczonka A; Poznan University of Medical Sciences, Depratment of Pediatric Oncology, Hematology and HSCT, Poznan, Poland., Yaniv I; The Raina Zaizov Pediatric Hematology Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel., Lankester A; Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands., Bierings M; Department of Hematology, University Hospital of Children, Utrecht, the Netherlands., Yesilipek A; Pediatric Stem Cell Transplantation Unit, Medical Park Antalya Hospital, Antalya, Turkey., Sedlacek P; Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic., Ifversen M; Rigshospitalet, Paediatric Clinic II, Copenhagen, Denmark., Svec P; Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia., Toporski J; Department of Hematology, Skanes University Hopsital, Lund, Sweden., Gungor T; Pediatric Stem Cell Transplantation, UZH, University of Zurich, Zurich, Switzerland., Wachowiak J; Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands., Glogova E; St Anna Children's Hospital, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria., Poetschger U; St Anna Children's Hospital, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria., Peters C; St Anna Children's Hospital, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria. |
| Abstrakt: |
Allogeneic HSCT represents the only potentially curative treatment for very high risk (VHR) ALL. Two consecutive international prospective studies, ALL-SCT-(I)BFM 2003 and 2007 were conducted in 1150 pediatric patients. 569 presented with VHR disease leading to any kind of HSCT. All patients >2 year old were transplanted after TBI-based MAC. The median follow-up was 5 years. 463 patients were transplanted from matched donor (MD) and 106 from mismatched donor (MMD). 214 were in CR1. Stem cell source was unmanipulated BM for 330 patients, unmanipulated PBSC for 135, ex vivo T-cell depleted PBSC for 62 and cord-blood for 26. There were more advanced disease, more ex vivo T-cell depletion, and more chemotherapy based conditioning regimen for patients transplanted from MMD as compared to those transplanted from MSD or MD. Median follow up (reversed Kaplan Meier estimator) was 4.99 years, median follow up of survivals was 4.88, range (0.01-11.72) years. The 4-year CI of extensive cGvHD was 13 ± 2% and 17 ± 4% (p = NS) for the patients transplanted from MD and MMD, respectively. 4-year EFS was statistically better for patients transplanted from MD (60 ± 2% vs. 42 ± 5%, p < 0.001) for the whole cohort. This difference does not exist if considering separately patients treated in the most recent study. There was no difference in 4-year CI of relapse. The 4-year NRM was lower for patients transplanted from MD (9 ± 1% vs. 23 ± 4%, p < 0.001). In multivariate analysis, donor-type appears as a negative risk-factor for OS, EFS, and NRM. This paper demonstrates the impact of donor type on overall results of allogeneic stem cell transplantation for very-high risk pediatric acute lymphoblastic leukemia with worse results when using MMD stem cell source. |
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