title: Survival differences between adolescents/young adults and children with B precursor acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation.
abstract: Risk-adapted therapy has been the cornerstone of treatment for pediatric B precursor acute lymphoblastic leukemia (B-ALL). Recently, age ≥ 13 years at diagnosis has been identified as a very high-risk feature for chemotherapy treated pediatric patients with B-ALL. Whether age at time of transplantation is associated with poor outcomes in adolescents and young adults (AYA) is unknown. We hypothesized that AYA receiving allogeneic hematopoietic cell transplantation (allo-HCT) would have greater relapse and inferior survival compared with children age <13 years. We reviewed the outcomes in 136 consecutive patients (age 0-30 years) with B-ALL who underwent myeloablative allo-HCT at our institution, including 79 children age <13 years (58%) and 57 AYA age 13-30 years (42%). Overall survival at 5 years was significantly lower in the AYA group (hazard ratio, 1.74; 95% confidence interval [CI], 1.04-2.95; P = .03). In addition, the AYA patients had a greater risk of transplantation-related mortality at 1 year (hazard ratio, 2.23; 95% CI, 1.01-4.90; P = .05), but no difference in relapse (relative risk, 0.85; 95% CI, 0.41-1.76; P = .66). Based on this analysis, AYA patients undergoing allo-HCT for B-ALL have significantly inferior survival and greater transplantation-related mortality compared with children age <13 years, but no difference in relapse, suggesting that allo-HCT may overcome relapse in AYA. Further improvements in peritransplantation care are needed to limit complications in AYA patients.
authors.affiliation: Division of Pediatric Hematology-Oncology, University of Minnesota, Amplatz Children's Hospital, Minneapolis, Minnesota 55455, USA. burke283@umn.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Burke
authors.forename: Nathan
authors.initials: N
authors.lastname: Gossai
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
authors.forename: Angela R
authors.initials: AR
authors.lastname: Smith
authors.forename: Veronika
authors.initials: V
authors.lastname: Bachanova
authors.forename: Qing
authors.initials: Q
authors.lastname: Cao
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.forename: Heather S
authors.initials: HS
authors.lastname: Stefanski
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Michael R
authors.initials: MR
authors.lastname: Verneris
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous; D055815:Young Adult