Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia
| Autor: | Şebnem Yılmaz, Suar Çakı Kılıç, Alphan Kupesiz, Volkan Hazar, Savaş Kansoy, Fatma Visal Okur, Musa Karakukcu, Orhan Gürsel, Ibrahim Bayram, Vedat Uygun, Yöntem Yaman, Ceyhun Bozkurt, Elif Güler, Arzu Akcay, Gülyüz Öztürk, Mehmet Ertem, Gülsün Karasu, Müge Gökçe, Duygu Uckan, Tunç Fışgın, Namik Ozbek, Talia Ileri, Barbaros Şahin Karagün, Akif Yeşilipek, Serap Aksoylar, Ülker Koçak, Tekin Aksu |
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| Přispěvatelé: | Ege Üniversitesi, İstinye Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Ceyhun Bozkurt / 0000-0001-6771-9894, Bozkurt, Ceyhun |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Oncology
Male medicine.medical_specialty Subsequent Relapse Adolescent Turkey medicine.medical_treatment 030232 urology & nephrology Salvage therapy Hematopoietic stem cell transplantation post‐ 030230 surgery transplant relapse 03 medical and health sciences Young Adult 0302 clinical medicine children Recurrence Internal medicine medicine Humans Transplantation Homologous acute leukemia Child Cause of death Retrospective Studies Salvage Therapy Transplantation Acute leukemia Leukemia treatment business.industry Hazard ratio Hematopoietic Stem Cell Transplantation Infant Newborn Infant Prognosis Post-Transplant Relapse Combined Modality Therapy Survival Analysis surgical procedures operative Child Preschool Pediatrics Perinatology and Child Health Cohort Acute Disease Female business Follow-Up Studies |
| Popis: | 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. WOS:000598672000001 33320995 Q4 |
| Databáze: | OpenAIRE |
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