title: Improvement of overall survival after allogeneic hematopoietic stem cell transplantation for children and adolescents: a three-decade experience of a single institution.
abstract: Allogeneic stem cell transplantation (allo-SCT) has become an essential component of the treatment for a variety of diseases in pediatric patients. During the past decades, advances in the transplant technology, availability of hematopoietic stem cells and supportive care not only have resulted in improved outcomes, but also have expanded the transplant options. However, these features have been studied mainly in adult populations. This investigation analyzed changes in patient profile, transplantation, graft characteristics and outcome among 250 children and adolescent patients who received allo-SCT in a single center between 1983 and 2010. In the 2000-2010, compared with the 1983-1999 period, a significantly higher 5-year overall survival (64% versus 52%, P=0.03) was observed together with a significant decrease of non-relapse mortality (27% versus 9%, P=0.0002). The progression-free survival was comparable between the two periods (49% versus 57%; P=0.17). The 5-year cumulative incidence of relapse was 24% between 1983 and 1999, and 34% between 2000 and 2010 (P=0.08). Major advances in supportive care practice have been made over the past decade, resulting in a significant survival benefit for the pediatric population undergoing allo-SCT. However, post-transplant relapse remains the leading cause of failure of this therapeutic approach, and preventing relapse represents a major challenge today.
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Brissot
authors.affiliation: Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Nantes, France.
authors.forename: F
authors.initials: F
authors.lastname: Rialland
authors.affiliation: Service d'Hématologie Clinique, CHU de Rennes, Rennes, France.
authors.forename: X
authors.initials: X
authors.lastname: Cahu
authors.affiliation: Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Strullu
authors.affiliation: Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Nantes, France.
authors.forename: N
authors.initials: N
authors.lastname: Corradini
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.|Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Nantes, France.
authors.forename: N
authors.initials: N
authors.lastname: Blin
authors.affiliation: Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Nantes, France.
authors.forename: X
authors.initials: X
authors.lastname: Rialland
authors.affiliation: Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Thebaud
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.|Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Moreau
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.|Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Harousseau
authors.affiliation: Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Nantes, France.
authors.forename: F
authors.initials: F
authors.lastname: Mechinaud
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D015996:Survival Rate