Abstract
Objective To study of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk or relapsed childhood acute lymphoblastic leukemia (ALL) in first complete remission (CR1) or second complete remission (CR2), analyzing the outcomes and the impact factors. Methods A total of 34 cases of childhood ALL in high-risk or CR2 received allo-HSCT from April 2001 to May 2013 in SUN Yat-sen Memorial Hospital were selected into this study. Among them, 28 cases were B-cell ALL (B-ALL) and 6 cases were T-cell ALL (T-ALL); 26 cases were high-risk in CR1 and 3 cases were in CR2. According to the different donor for allo-HSCT, they were divided into match sibling donor-peripheral blood stem cell transplantation (MSD-PBSCT) group (n=5), unrelated donor-umbilical cord blood transplantation (UD-UCBT) group (n=11), and unrelated donor-peripheral blood stem cell transplantation (UD-PBSCT) group (n=18). Conditioning regimens for allo-HSCT included: busulphan (BU) + cyclophosphamide (CY), fludarabine (Flud)and human anti-thymocyte globulin (ATG). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of SUN Yat-sen Memorial Hospital, SUN Yat-sen University. Informed consent was obtained from the parents of each participating child. Results After treatment by allo-HSCT, incidence rate of acute GVHD (aGVHD) was 33.3%, and the rate of Ⅲ-Ⅳ degrees aGVHD was 16.7%(5/30), the rate of chronic GVHD (cGVHD) was 51.8% (14/27) among 34 cases children with high-risk and relapsed ALL. Incidence rate of aGVHD in UD-PBSCT group was higher than those in other two groups. The rates of 5-year disease free survival (DFS) and overall survival (OS) were (57.7±6)% (15/26) and (61.5±8.3)% (16/26) respectively. A total of 8 cases children with high-risk and relapsed ALL died of transplant-related mortality (TRM), the rate of TRM was 23.5% (8/34). The rate of TRM in ALL children with CR2 were higher than those in ALL children with CR1, and there was significant difference (P<0.05). The major cause of the TRM was infection, and the other causes were autoimmune hemolytic anemia, severe GVHD and lymphoproliferative disorder. After treatment by allo-HSCT, among 34 cases children with high-risk and relapsed ALL, 6 cases relapsed, the relapse rate was 19.4% (6/31), and there were no significant correlation between recurrence and source of hematopoietic stem cell. The rate of relapsed was higher in patients without cGVHD, and none of the patients with cGVHD relapsed. Conclusions Allo-HSCT is considered as treatment for high-risk or relapsed childhood ALL, the 5-year OS rate exceeded 50%. The outcomes of allo-HSCT in childhood ALL in CR1 are better than those in CR2. Patients with cGVHD are manifested low relapse rate. Key words: Leukemia, lymphoblastic, acute; Hematopoietic stem cell transplantation; Graft versus host reaction; Child
Published Version
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