Journal
HEMATOLOGICAL ONCOLOGY
Volume 40, Issue 3, Pages 457-468Publisher
WILEY
DOI: 10.1002/hon.2980
Keywords
adolescent; child; graft versus host disease; lymphoid leukemia; stem cell transplantation
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This study retrospectively analyzed the outcomes of hematopoietic stem cell transplantation (HSCT) in children and adolescents with T-cell acute lymphoblastic leukemia (T-ALL). The results showed that HSCT at the first complete remission had better survival rates, but once relapse occurred, the prognosis was worse. Higher grades of graft versus host disease were associated with lower overall and leukemia free survival rates. Cord blood transplantation with total-body irradiation-based myeloablative conditioning showed better outcomes compared to other conditioning regimens.
Acute lymphoblastic leukemia (ALL) is the most common cancer during childhood, and some high-risk patients with ALL require hematopoietic stem cell transplantation (HSCT). Mainly due to small patient numbers, studies focusing specifically on children and adolescents with T-cell ALL (T-ALL) are limited. Using a nationwide registry, we retrospectively analyzed data from patients under 20 years old who underwent their first HSCT for T-ALL between 2000 and 2018. As a result, total 484 patients were included, and their median follow-up period was 6.9 years after HSCT for survivors. While patients receiving HSCT at first complete remission (CR) showed relatively good 5-year leukemia free survival (5yLFS, 73.5%), once relapse occurred, their prognosis was much worse (44.4%) even if they attained second remission again (p < 0.001). Among patients receiving HSCT at CR1, grade II-IV acute graft versus host disease was associated with worse overall and LFS than grade 0-I (5yLFS 69.5% vs. 82.1%, p = 0.026) mainly due to high non-relapse mortality. Among those patients, patients receiving related bone marrow transplantation, unrelated bone marrow transplantation, or unrelated cord blood transplantation showed similar survival (5yLFS, 73.2%, 76.3%, and 77.0%, respectively). For patients undergoing cord blood transplantation at CR1, total-body irradiation-based myeloablative conditioning was associated with better 5yLFS than other conditioning regimens (85.4% vs. 62.2%, p = 0.044), as it reduced the risk of relapse. These results indicate that relapsed patients have much less chance of cure, and that identifying patients who require HSCT for cure and offering them HSCT with optimal settings during CR1 are crucial for children and adolescents with T-ALL.
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