title: Prognostic factors for outcomes of pediatric patients with refractory or relapsed acute leukemia undergoing allogeneic progenitor cell transplantation.
abstract: Allogeneic stem cell transplantation (SCT) is the only curative therapy for patients with refractory or relapsed acute leukemia, although the prognosis remains poor. Few reports have described outcomes of SCT in pediatric patients with refractory acute leukemia. To identify prognostic factors for these patients, we retrospectively evaluated SCT outcomes for advanced acute leukemia in 82 pediatric patients from 3 transplant units in Nagoya City between 1990 and 2008. Median age at transplantation was 8 years (range, 0.5-17 years). Transplantation was performed in the first refractory relapse for 53 patients (64.6%), in the second or subsequent relapse for 16 patients (19.5%), and during primary induction failure for 13 patients (15.9%). Only 4 patients (4.9%) underwent transplantation in the untreated first relapse, and 39 patients (47.6%) received unrelated donor progenitor cells. Of the 82 patients, 61 died (77.9%), with a median survival of 7.1 months (95% confidence interval [CI], 4.2-10.0 months). Median disease-free survival (DFS) was 4.7 months (95% CI, 2.6-6.9 months). In multivariate analysis, peripheral blood blasts, cord blood transplantation, and more than 3 courses of previous salvage chemotherapy were predictive of DFS. These results support the notion that allogeneic SCT offers only a small chance of cure for most pediatric patients with refractory or relapsed acute leukemia, and suggest that reduction of the leukemia burden and earlier optimal timing of transplantation are essential for long-term survival even in patients with refractory acute leukemia.
authors.affiliation: Division of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan. nobuhiro.watanabe@sch.pref.shizuoka.jp
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Watanabe
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Asahito
authors.initials: A
authors.lastname: Hama
authors.forename: Hideki
authors.initials: H
authors.lastname: Muramatsu
authors.forename: Sayoko
authors.initials: S
authors.lastname: Doisaki
authors.forename: Keizo
authors.initials: K
authors.lastname: Horibe
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Seiji
authors.initials: S
authors.lastname: Kojima
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000401:mortality* / Q000517:prevention & control*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014184:Transplantation, Homologous