title: Outcome of allogeneic hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia in second complete remission: a single institution study.
abstract: OBJECTIVE
  The survival rate for childhood acute lymphoblastic leukemia (ALL) has improved significantly. However, overall prognosis for the 20 to 25% of patients who relapse is poor, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the best chance for cure. In this study, we identified significant prognostic variables by analyzing the outcomes of allogeneic HSCT in ALL patients in second complete remission (CR).
  
  
  METHODS
  Fifty-three ALL patients (42 men, 79%) who received HSCT in second CR from August 1991 to February 2009 were included (26 sibling donor HSCTs, 49%; 42 bone marrow transplantations, 79%). Study endpoints included cumulative incidence of acute and chronic graft-versus-host disease (GVHD), relapse, 1-year transplant-related mortality (TRM), disease-free survival (DFS), and overall survival (OS).
  
  
  RESULTS
  Cumulative incidences of acute GVHD (grade 2 or above) and chronic GVHD were 45.3% and 28.5%, respectively. The estimated 5-year DFS and OS for the cohort was 45.2±6.8% and 48.3±7%, respectively. Only donor type, i.e., sibling versus unrelated, showed significant correlation with DFS in multivariate analysis (P=0.010). The rates of relapse and 1 year TRM were 28.9±6.4% and 26.4±6.1%, respectively, and unrelated donor HSCT (P=0.002) and HLA mismatch (P=0.022) were significantly correlated with increased TRM in univariate analysis.
  
  
  CONCLUSIONS
  In this single institution study spanning more than 17 years, sibling donor HSCT was the only factor predicting a favorable result in multivariate analysis, possibly due to increased TRM resulting from unrelated donor HSCT.
authors.affiliation: Department of Pediatrics, The Catholic University of Korea, School of Medicine, Seoul, Korea.
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Lee
authors.forename: Ji Yoon
authors.initials: JY
authors.lastname: Han
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Pil-Sang
authors.initials: PS
authors.lastname: Jang
authors.forename: Nack-Gyun
authors.initials: NG
authors.lastname: Chung
authors.forename: Dae-Chul
authors.initials: DC
authors.lastname: Jeong
authors.forename: Bin
authors.initials: B
authors.lastname: Cho
authors.forename: Hack-Ki
authors.initials: HK
authors.lastname: Kim