Transplant Outcomes for Children with T Cell Acute Lymphoblastic Leukemia in Second Remission: A Report from the Center for International Blood and Marrow Transplant Research.
Survival for children with relapsed T cell acute lymphoblastic leukemia (T-ALL) is poor when treated with chemotherapy alone, and outcomes after allogeneic hematopoietic cell transplantation (HCT) is not well described. Two hundred twenty-nine children with T-ALL in second complete remission (CR2) received an HCT after myeloablative conditioning between 2000 and 2011 and were reported to the Center for International Blood and Marrow Transplant Research. Median age was 10 years (range, 2 to 18). Donor source was umbilical cord blood (26%), matched sibling bone marrow (38%), or unrelated bone marrow/peripheral blood (36%). Acute (grades II to IV) and chronic graft-versus-host disease occurred in, respectively, 35% (95% confidence interval [CI], 27% to 45%) and 26% (95% CI, 20% to 33%) of patients. Transplant-related mortality at day 100 and 3-year relapse rates were 13% (95% CI, 9% to 18%) and 30% (95% CI, 24% to 37%), respectively. Three-year overall survival and disease-free survival rates were 48% (95% CI, 41% to 55%) and 46% (95% CI, 39% to 52%), respectively. In multivariate analysis, patients with bone marrow relapse, with or without concurrent extramedullary relapse before HCT, were most likely to relapse (hazard ratio, 3.94; P = .005) as compared with isolated extramedullary disease. In conclusion, HCT for pediatric T-ALL in CR2 demonstrates reasonable and durable outcomes, and consideration for HCT is warranted.
Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI. Electronic address: mmburke@mcw.edu.
Michael J
MJ
Burke
Department of Pediatrics, University of Minnesota, Minneapolis, MN.
Michael R
MR
Verneris
CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI.
Jennifer
J
Le Rademacher
CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
Wensheng
W
He
Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.
Hisham
H
Abdel-Azim
Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC.
Allistair A
AA
Abraham
Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH.
Jeffery J
JJ
Auletta
Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
Mouhab
M
Ayas
Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, PA.
Valerie I
VI
Brown
Department of Pediatrics, New York Medical College, Valhalla, NY.
Mitchell S
MS
Cairo
Department of Pediatrics, Texas Transplant Institute, San Antonio, TX.
Ka Wah
KW
Chan
Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
Miguel A
MA
Diaz Perez
Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA.
Christopher C
CC
Dvorak
Department of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.
R Maarten
RM
Egeler
Department of Pediatrics, University of Florida, Gainsville, FL.
Lamis
L
Eldjerou
Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
Haydar
H
Frangoul
Section of Paediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, AB, Canada.
Gregory M T
GMT
Guilcher
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO.
Robert J
RJ
Hayashi
Department of Hematology/Oncology, Makassed General Hospital, Beiruit, Lebanon.
Ahmed
A
Ibrahim
Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Kimberly A
KA
Kasow
Division of Bone Marrow Transplantation, St. Jude Children's Research Hospital, Memphis, TN.
Wing H
WH
Leung
Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Richard F
RF
Olsson
Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.
Michael A
MA
Pulsipher
Division of Hematology/Oncology, Department of Pediatrics, Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, AZ.
Niketa
N
Shah
Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NIH), Bethesda, MD.
Nirali N
NN
Shah
CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
Elizabeth
E
Thiel
Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI.
Julie-An
JA
Talano
Stem Cell Transplant Program, Department of Pediatrics, Vanderbilt University, Nashville, TN.
Carrie L
CL
Kitko
D000046:Academic Medical Centers; D000208:Acute Disease; D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007391:International Cooperation; D008297:Male; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012720:Severity of Illness Index; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists
Acute lymphoblastic leukemia; Pediatric; Relapse; T-cell ALL; Transplantation