title: Keep in Mind Quality of Life: Outcome of a Ten-Year Series of Post-Transplantation Early Relapses in Childhood Acute Lymphoblastic Leukemia-A Report from the Grand Ouest Oncology Study Group for Children in France.
abstract: Relapses of acute lymphoblastic leukemia (ALL) early after hematopoietic stem cell transplantations in children are uncommon but associated with a very poor prognosis. Whereas there are no current recommendations for the management of these relapses, the children's quality of life is an important issue. We studied the outcomes, including 1-year overall survival, complete remission, and quality of life, of 19 children with ALL who relapsed within the first year after their transplantation treated in the 5 participating centers between 2000 and 2011 Patients were distributed as follows: supportive care only (group A), outpatient treatment (mainly steroid and vincristine, group B), or intensive inpatient treatment (group C). There were no significant differences in 1-year overall survival (31.5% for the entire cohort) or remission rate for time between transplantation and relapse (< 6 months or 6 to 12 months), transplantation or disease characteristics, or treatment group. However, time spent in hospital (for treatment and complications) significantly differed between treatment groups B and C (20.8% ± 13.0 versus 59.1% ± 32.9, respectively; P < .05). No differences in organ toxicities, school attendance, or Lansky scores were found between treatment groups. Our sample size-limited data indicate, in a prepersonalized medicine era, that children treated with steroid and vincristine have the same prognosis as those treated with intensive therapy, but they may benefit from improved quality of life. Nevertheless, new therapeutic strategies are required and future prospective trials would help to establish recommendations.
authors: Department of Pediatrics and Genetics, University Hospital of Brest, Brest, France. Electronic address: sophie.haro@chu-brest.fr.
authors: Sophie
authors: S
authors: Haro
authors: Grand Ouest Oncology Study Group for Children Biostatistic Unit, University Hospital of Rennes, France.
authors: Aude
authors: A
authors: Tavenard
authors: Department of Pediatric Hematology/Oncology, University Hospital of Nantes, Nantes, France.
authors: Fanny
authors: F
authors: Rialland
authors: Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes 1 University, France.
authors: Sophie
authors: S
authors: Taque
authors: Department of Clinical Haematology, Institute of Cancerology and Hematology, University Hospital Brest, Brest, France.
authors: Gaelle
authors: G
authors: Guillerm
authors: Department of Pediatric Onco-Hematology, University Hospital of Tours, Tours, France.
authors: Pascale
authors: P
authors: Blouin
authors: Grand Ouest Oncology Study Group for Children Biostatistic Unit, University Hospital of Rennes, France.
authors: Maxime
authors: M
authors: Esvan
authors: Department of Pediatric Onco-Hematology, University Hospital of Angers, Angers, France.
authors: Isabelle
authors: I
authors: Pellier
authors: Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes 1 University, France.
authors: Virginie
authors: V
authors: Gandemer
mesh_terms: D000293:Adolescent; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D011788:Quality of Life; D015996:Survival Rate; D013997:Time Factors
keywords: Children; Early; Hematopoietic stem cell transplantation; Lymphoblastic leukemia; Relapse