title: Treatment of relapse after allogeneic stem cell transplantation in children and adolescents with ALL: the Frankfurt experience.
abstract: Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach). If this was not feasible, low-dose chemotherapy and donor lymphocyte infusions (LDCHT+DLI) were offered (non-transplant approach). A total of 23 patients suffered a post-transplant relapse. Eight patients received HDCHT/SIT, followed by haploidentical SCT in 7/8. Ten received LDCHT+DLI. The eight patients treated with a second transplant and the ten treated with the non-transplant approach had a 4-year overall survival of 56% and 40%, respectively (P=0.232). Prerequisites for successful treatment of post-transplant relapse by either a second transplant or experimental non-transplant approaches are good clinical condition and the capacity to achieve haematological remission by the induction treatment element.
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: A M
authors.initials: AM
authors.lastname: Willasch
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Salzmann-Manrique
authors.affiliation: Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Krenn
authors.affiliation: Department of Pediatric Oncology, University of Mannheim, Mannheim, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Duerken
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital of Johannes Gutenberg University, Mainz, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Faber
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital of Johannes Gutenberg University, Mainz, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Opper
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Kreyenberg
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bager
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Huenecke
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Cappel
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bremm
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Pfirrmann
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Merker
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Ullrich
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Bakhtiar
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Rettinger
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Jarisch
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Soerensen
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: T E
authors.initials: TE
authors.lastname: Klingebiel
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bader
mesh_terms: D000293:Adolescent; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D007167:Immunotherapy; D007223:Infant; D017710:Lymphocyte Transfusion; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014019:Tissue Donors