Effects of second transplantation with T-cell-replete haploidentical graft using low-dose anti-thymocyte globulin on long-term overall survival in pediatric patients with relapse of leukemia after first allogeneic transplantation.
Shogo KobayashiHideki SanoKazuhiro MochizukiYoshihiro OharaNobuhisa TakahashiShingo KudoKazuhiko IkedaHitoshi OhtoAtsushi KikutaPublished in: International journal of hematology (2021)
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the preferred treatment for children with high-risk hematologic malignancies, but post-allo-HSCT relapse has a poor prognosis and limited treatment options. We evaluated the feasibility, outcome, and risk factors influencing survival after T-cell-replete haploidentical HSCT with low-dose anti-thymocyte globulin (ATG) in 30 patients with post-allo-HSCT relapse of acute lymphoblastic leukemia and acute myeloid leukemia. Overall, 50% of the patients had complete remission (CR) before the second transplant and the overall survival (OS) rate was 52%. In surviving patients (median follow-up 614 days), Kaplan-Meier analysis revealed estimated 2-year leukemia-free survival and OS rates of 48.1% and 61.1%, respectively. Cumulative incidences of 2-year non-relapse mortality and relapse were 24.7% and 36.3%, respectively. Achieving CR before the second allo-HSCT was a predominant independent prognostic factor identified in the multivariate analysis, with a significantly improved 2-year OS rate of 86.7%. T-cell-replete haplo-HSCT with low-dose ATG for second allo-HSCT may benefit a selected patient population.
Keyphrases
- free survival
- low dose
- acute myeloid leukemia
- hematopoietic stem cell
- prognostic factors
- allogeneic hematopoietic stem cell transplantation
- acute lymphoblastic leukemia
- poor prognosis
- bone marrow
- end stage renal disease
- stem cell transplantation
- ejection fraction
- high dose
- newly diagnosed
- chronic kidney disease
- long non coding rna
- young adults
- patient reported outcomes
- cardiovascular events
- peripheral blood
- risk factors
- mesenchymal stem cells
- replacement therapy
- disease activity
- smoking cessation
- ulcerative colitis
- patient reported