title: High success rate of hematopoietic cell transplantation regardless of donor source in children with very high-risk leukemia.
abstract: We evaluated 190 children with very high-risk leukemia, who underwent allogeneic hematopoietic cell transplantation in 2 sequential treatment eras, to determine whether those treated with contemporary protocols had a high risk of relapse or toxic death, and whether non-HLA-identical transplantations yielded poor outcomes. For the recent cohorts, the 5-year overall survival rates were 65% for the 37 patients with acute lymphoblastic leukemia and 74% for the 46 with acute myeloid leukemia; these rates compared favorably with those of earlier cohorts (28%, n = 57; and 34%, n = 50, respectively). Improvement in the recent cohorts was observed regardless of donor type (sibling, 70% vs 24%; unrelated, 61% vs 37%; and haploidentical, 88% vs 19%), attributable to less infection (hazard ratio [HR] = 0.12; P = .005), regimen-related toxicity (HR = 0.25; P = .002), and leukemia-related death (HR = 0.40; P = .01). Survival probability was dependent on leukemia status (first remission vs more advanced disease; HR = 0.63; P = .03) or minimal residual disease (positive vs negative; HR = 2.10; P = .01) at the time of transplantation. We concluded that transplantation has improved over time and should be considered for all children with very high-risk leukemia, regardless of matched donor availability.
authors: Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. wing.leung@stjude.org
authors: Wing
authors: W
authors: Leung
authors: Dario
authors: D
authors: Campana
authors: Jie
authors: J
authors: Yang
authors: Deqing
authors: D
authors: Pei
authors: Elaine
authors: E
authors: Coustan-Smith
authors: Kwan
authors: K
authors: Gan
authors: Jeffrey E
authors: JE
authors: Rubnitz
authors: John T
authors: JT
authors: Sandlund
authors: Raul C
authors: RC
authors: Ribeiro
authors: Ashok
authors: A
authors: Srinivasan
authors: Christine
authors: C
authors: Hartford
authors: Brandon M
authors: BM
authors: Triplett
authors: Mari
authors: M
authors: Dallas
authors: Asha
authors: A
authors: Pillai
authors: Rupert
authors: R
authors: Handgretinger
authors: Joseph H
authors: JH
authors: Laver
authors: Ching-Hon
authors: CH
authors: Pui
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