Autologous purified peripheral blood SCT in childhood low-risk relapsed ALL.
The treatment of childhood B-cell-precursor ALL after isolated-extramedullary or late relapse is controversial. Most approaches are based on chemotherapy or allogeneic transplantation. The aim of this report is to assess the long-term outcome of children with 'low-risk' relapsed ALL treated according to a prospective purified auto-transplantation protocol. From January 1997 to March 2004, at a single pediatric Center, 30 ALL consecutive children, lacking an HLA-identical sibling, were treated according to the autologous purified peripheral blood stem cell protocol after isolated-extramedullary (7) or late medullary (24) relapse. After the 'DIAVE' mobilizing regimen a median of 11.6 × 10(6)CD34+/Kg (range 3.9-27.4) were collected. Leukaphereses were depleted by 99% of CD19+cells (range 98-100) by means of a double step immunological purification. The conditioning regimen included TBI. No early severe complications nor transplant-related deaths occurred; late effects, as expected, mostly consisted in endocrinological issues and were assessed at a median follow-up of 8.5 years. Five-year-EFS and survival were 68.5% (s.e. 7.9) and 85.7% (s.e. 5.9), respectively, for the 35 eligible patients and 70.0% (s.e. 8.4) and 86.7% (s.e. 6.2) for the 30 patients actually transplanted as per protocol. The outcome of this series favorably compares with historical data regarding both autologous transplantation and standard salvage chemotherapy.
Balduzzi
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Clinica Pediatrica, Università degli Studi di Milano Bicocca, Monza, Italy. a.balduzzi@hsgerardo.org
Bonanomi
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S
Valsecchi
M G
MG
Gaipa
G
G
Perseghin
P
P
Songia
S
S
Maglia
O
O
Rossi
V
V
Motta
S
S
Di Maio
L
L
Dassi
M
M
Uderzo
C
C
Conter
V
V
Henze
G
G
von Stackelberg
A
A
Rovelli
A
A
Biondi
A
A
Galimberti
S
S
D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D018365:Neoplasm, Residual / Q000175:diagnosis; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D012008:Recurrence; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous