title: Outcome of myeloablative conditioning and unrelated donor hematopoietic cell transplantation for childhood acute lymphoblastic leukemia in third remission.
abstract: We conducted a retrospective study of 155 children who underwent unrelated donor hematopoietic cell transplantation (HCT) between 1990 and 2005 for acute lymphoblastic leukemia in third remission. The median patient age was 11 years, the median time from diagnosis to first relapse was 36 months, and the median time from first relapse to second relapse was 26 months. Stem cell sources were bone marrow (n = 115), peripheral blood (n = 11), and cord blood (n = 29). All patients received a myeloablative pretransplantation conditioning regimen. The 5-year estimates of leukemia-free survival, relapse, and nonrelapse mortality were 30%, 25%, and 45%, respectively. In multivariate analysis, the only risk factor associated with relapse was the interval between the first relapse and the second relapse. Second relapses occurring >26 months from the first relapse were associated with lower risk for post-HCT relapse compared with second relapses occurring at ≤26 months (relative risk, 0.4; P = .01). Relapse risk was lowest when late second relapse was preceded by late first relapse (>36 months from diagnosis), as demonstrated by a 3-year relapse rate of 9% (P = .0009). Our data indicate that long-term leukemia-free survival can be achieved in children with acute lymphoblastic leukemia in third remission using unrelated donor HCT, especially when the second relapse occurs late.
authors.affiliation: Pediatric Blood and Marrow Transplant Program, Doernbecher Children's Hospital, Portland, Oregon, USA.
authors.forename: Eneida R
authors.initials: ER
authors.lastname: Nemecek
authors.forename: Kristin
authors.initials: K
authors.lastname: Ellis
authors.forename: Wensheng
authors.initials: W
authors.lastname: He
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Bunin
authors.forename: Rajinder S
authors.initials: RS
authors.lastname: Bajwa
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cheerva
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Christopher
authors.initials: C
authors.lastname: Dvorak
authors.forename: Michel
authors.initials: M
authors.lastname: Duval
authors.forename: Stella
authors.initials: S
authors.lastname: Davies
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gross
authors.forename: Ayad A
authors.initials: AA
authors.lastname: Hussein
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.forename: Parinda A
authors.initials: PA
authors.lastname: Mehta
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.forename: Adriana
authors.initials: A
authors.lastname: Seber
authors.forename: Ann E
authors.initials: AE
authors.lastname: Woolfrey
authors.forename: Haydar A
authors.initials: HA
authors.lastname: Frangoul
authors.forename: Paul A
authors.initials: PA
authors.lastname: Carpenter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D061349:Unrelated Donors