Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 17, Issue 12, Pages 1833-1840Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2011.05.014
Keywords
BMT; HCT; Advanced ALL; Nonrelapse mortality
Categories
Funding
- Public Health Service from the National Cancer Institute (NCI) [U24-CA76518]
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and infectious Diseases (NIAID)
- NHLBI [5U01HL069294]
- NCI
- Health Resources and Services Administration [HHSH234200637015C]
- Office of Naval Research [N00014-06-1-0704, N00014-08-1-0058]
- AABB
- Allos Inc
- Amgen Inc
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We conducted a retrospective study of 155 children who underwent unrelated donor hematopoietic cell transplantation (HCT) between 1990 and 2005 for acute lymphoblastic leukemia in third remission. The median patient age was 1 I years, the median time from diagnosis to first relapse was 36 months, and the median time from first relapse to second relapse was 26 months. Stem cell sources were bone marrow (n = 115), peripheral blood (n = I I), and cord blood (n = 29). All patients received a myeloablative pre-transplantation conditioning regimen. The 5-year estimates of leukemia-free survival, relapse, and nonrelapse mortality were 30%, 25%, and 45%, respectively. In multivariate analysis, the only risk factor associated with relapse was the interval between the first relapse and the second relapse. Second relapses occurring >26 months from the first relapse were associated with lower risk for post-HCT relapse compared with second relapses occurring at <= 26 months (relative risk, 0.4; P =.01). Relapse risk was lowest when late second relapse was preceded by late first relapse (>36 months from diagnosis), as demonstrated by a 3-year relapse rate of 9% (P =.0009). Our data indicate that long-term leukemia-free survival can be achieved in children with acute lymphoblastic leukemia in third remission using unrelated donor HCT, especially when the second relapse occurs late. Biol Blood Marrow Transplant 17: 1833-1840 (2011) (C) 2011 American Society for Blood and Marrow Transplantation
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