title: Transplantation Outcomes for Children with Hypodiploid Acute Lymphoblastic Leukemia.
abstract: Children with hypodiploid acute lymphoblastic leukemia (ALL) have inferior outcomes despite intensive risk-adapted chemotherapy regimens. We describe 78 children with hypodiploid ALL who underwent hematopoietic stem cell transplantation between 1990 and 2010. Thirty-nine (50%) patients had ≤ 43 chromosomes, 12 (15%) had 44 chromosomes, and 27 (35%) had 45 chromosomes. Forty-three (55%) patients underwent transplantation in first remission (CR1) and 35 (45%) underwent transplantation in ≥ second remission (CR2). Twenty-nine patients (37%) received a graft from a related donor and 49 (63%) from an unrelated donor. All patients received a myeloablative conditioning regimen. The 5-year probabilities of leukemia-free survival, overall survival, relapse, and treatment-related mortality for the entire cohort were 51%, 56%, 27%, and 22%, respectively. Multivariate analysis confirmed that mortality risks were higher for patients who underwent transplantation in CR2 (hazard ratio, 2.16; P = .05), with number of chromosomes ≤ 43 (hazard ratio, 2.15; P = .05), and for those who underwent transplantation in the first decade of the study period (hazard ratio, 2.60; P = .01). Similarly, treatment failure risks were higher with number of chromosomes ≤ 43 (hazard ratio, 2.28; P = .04) and the earlier transplantation period (hazard ratio, 2.51; P = .01). Although survival is better with advances in donor selection and supportive care, disease-related risk factors significantly influence transplantation outcomes.
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Parinda.mehta@cchmc.org.
authors: Parinda A
authors: PA
authors: Mehta
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Mei-Jie
authors: MJ
authors: Zhang
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Mary
authors: M
authors: Eapen
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Wensheng
authors: W
authors: He
authors: Pediatric Oncology Institute, Hospital Samaritano, Sao Paulo, Brazil.
authors: Adriana
authors: A
authors: Seber
authors: Schiehallion Day Care Unit, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.
authors: Brenda
authors: B
authors: Gibson
authors: Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors: Bruce M
authors: BM
authors: Camitta
authors: Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan.
authors: Carrie L
authors: CL
authors: Kitko
authors: Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, California.
authors: Christopher C
authors: CC
authors: Dvorak
authors: Pediatric Blood and Marrow Transplant Program, Department of Pediatrics, Doernbecher Children's Hospital and Oregon Health and Science University, Portland, Oregon.
authors: Eneida R
authors: ER
authors: Nemecek
authors: Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Haydar A
authors: HA
authors: Frangoul
authors: Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
authors: Hisham
authors: H
authors: Abdel-Azim
authors: Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Kimberly A
authors: KA
authors: Kasow
authors: Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts.
authors: Leslie
authors: L
authors: Lehmann
authors: Stem Cell Transplant Unit, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
authors: Marta
authors: M
authors: Gonzalez Vicent
authors: Stem Cell Transplant Unit, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
authors: Miguel A
authors: MA
authors: Diaz Pérez
authors: Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors: Mouhab
authors: M
authors: Ayas
authors: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors: Muna
authors: M
authors: Qayed
authors: Department of Pediatrics, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Paul A
authors: PA
authors: Carpenter
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Sonata
authors: S
authors: Jodele
authors: Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors: Troy C
authors: TC
authors: Lund
authors: Division of Bone Marrow Transplantation, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Wing H
authors: WH
authors: Leung
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Stella M
authors: SM
authors: Davies
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000782:Aneuploidy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012306:Risk; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists
keywords: Hematopoietic stem cell transplantation; Hypodiploid acute lymphoblastic leukemia