title: Impact of marrow unrelated donor search duration on outcome of children with acute lymphoblastic leukemia in second remission.
abstract: We analyzed the outcome of 167 consecutive children with second CR acute lymphoblastic leukemia (ALL), for whom an unrelated donor (UD) search was activated between 1989 and 1998 at a median time of 2 months after relapse. A suitable donor was identified for 70 patients at 1 year and 6.5 months before and after 1995 from search activation, respectively; a further leukemia relapse occurred during the search in 94 children at a median of 4 months after search activation, 36 of whom underwent UD (14) or other types of transplant (22), beyond second CR, while 58 died of progressive disease. Of 73 patients not experiencing a second relapse, 64 underwent UD (46) or other types of transplant (18), while nine proceeded with chemotherapy, and only four of them survived. The 3-year disease-free survival (DFS) from second CR for the 167 patients is 15.1%, whereas 3-year DFS after transplant for the 60 UD and 40 alternative donor transplanted children is 31.6 and 25.4%, respectively. In conclusion, a further relapse is the main factor adversely affecting outcome of children with second CR ALL. Thus, for these patients, the search should be activated early after relapse and either a UD or an alternative transplant should be performed as early as possible.
authors.affiliation: UO Ematologia ed Oncologia Pediatrica, Istituto G Gaslini, Genova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Dini
authors.forename: M Grazia
authors.initials: MG
authors.lastname: Valsecchi
authors.forename: C
authors.initials: C
authors.lastname: Micalizzi
authors.forename: A
authors.initials: A
authors.lastname: Busca
authors.forename: A
authors.initials: A
authors.lastname: Balduzzi
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.forename: S
authors.initials: S
authors.lastname: Cesaro
authors.forename: A
authors.initials: A
authors.lastname: Prete
authors.forename: M
authors.initials: M
authors.lastname: Rabusin
authors.forename: E
authors.initials: E
authors.lastname: Mazzolari
authors.forename: P
authors.initials: P
authors.lastname: Di Bartolomeo
authors.forename: N
authors.initials: N
authors.lastname: Sacchi
authors.forename: A
authors.initials: A
authors.lastname: Pession
authors.forename: G
authors.initials: G
authors.lastname: Giorgiani
authors.forename: E
authors.initials: E
authors.lastname: Lanino
authors.forename: T
authors.initials: T
authors.lastname: Lamparelli
authors.forename: C
authors.initials: C
authors.lastname: Favre
authors.forename: A
authors.initials: A
authors.lastname: Bosi
authors.forename: C
authors.initials: C
authors.lastname: Manzitti
authors.forename: S
authors.initials: S
authors.lastname: Galimberti
authors.forename: F
authors.initials: F
authors.lastname: Locatelli
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome