title: Outcome after failure of allogeneic hematopoietic stem cell transplantation in children with acute leukemia: a study by the société Francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).
abstract: Allogeneic hematopoietic stem cell transplantation (SCT) contributes to improved outcome in childhood acute leukemia (AL). However, therapeutic options are poorly defined in the case of post-transplantation relapse. We aimed to compare treatment strategies in 334 consecutive children with acute leukemia relapse or progression after SCT in a recent 10-year period. Data could be analyzed in 288 patients (157 ALL, 123 AML and 8 biphenotypic AL) with a median age of 8.16 years at transplantation. The median delay from first SCT to relapse or progression was 182 days. The treatment consisted of chemotherapy alone (n=108), chemotherapy followed by second SCT (n=70), supportive/palliative care (n=67), combination of chemotherapy and donor lymphocyte infusion (DLI; n=30), or isolated reinfusion of donor lymphocytes (DLI; n=13). The median OS duration after relapse was 164 days and differed according to therapy: DLI after chemotherapy=385 days, second allograft=391 days, chemotherapy=174 days, DLI alone=140 days, palliative care=43 days. A second SCT or a combination of chemotherapy and DLI yielded similar outcome (hazard ratio (HR)=0.85, P=0.53) unlike chemotherapy alone (HR=1.43 P=0.04), palliative care (HR=4.24, P<0.0001) or isolated DLI (HR=1,94, P<0.04). Despite limitations in this retrospective setting, strategies including immunointervention appear superior to other approaches, mostly in AML.
authors.affiliation: Service d'Hématologie Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet, Clinique, Nice, France.|Université de Nice-Sophia Antipolis, Nice, France.
authors.forename: C
authors.initials: C
authors.lastname: Roux
authors.affiliation: Department of Public Health, CHU de Nice, Nice, France.
authors.forename: K
authors.initials: K
authors.lastname: Tifratene
authors.affiliation: Hematology/Transplantation Unit, Saint Louis Hospital, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.affiliation: Pediatric Hematology Department, Hopital de La Timone, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Galambrun
authors.affiliation: Institute of Hematology and Oncology Paediatrics, Hospices Civils de Lyon, Lyon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Bertrand
authors.affiliation: Pediatric Hematology Department, CHU de Nantes, Nantes, France.
authors.forename: F
authors.initials: F
authors.lastname: Rialland
authors.affiliation: Pediatric Onco-Hematology Department, Hôpital des Enfants, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Jubert
authors.affiliation: Onco-Hematology Department, CHU Nancy-Brabois, Vandoeuvre les Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Pochon
authors.affiliation: Pediatric Onco-Hematology Department, CHU de Strasbourg, Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Paillard
authors.affiliation: Pediatric Onco-Hematology Department, CHU de Montpellier, Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Sirvent
authors.affiliation: Department of Pediatric Hematology-Oncology, Jeanne de Flandre Hospital, CHRU, Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: Nelken
authors.affiliation: Pediatric Onco-Hematology Department, CHU de Rouen, Rouen, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Vannier
authors.affiliation: Pediatric Onco-Hematology Department, CHU de Grenoble, Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Freycon
authors.affiliation: Haematology Department, CHU of Liège and University of Liège, Liège, Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Beguin
authors.affiliation: Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Lyon, France.
authors.forename: N
authors.initials: N
authors.lastname: Raus
authors.affiliation: Hematology Department, CHRU de Lille, Lille, France.
authors.forename: I
authors.initials: I
authors.lastname: Yakoub-Agha
authors.affiliation: Hematology Department, Saint-Antoine Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Pediatric Hematology Department, Hopital Robert Debré, Paris, France.
authors.forename: J-H
authors.initials: JH
authors.lastname: Dalle
authors.affiliation: Pediatric Hematology Department, Hopital de La Timone, Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Michel
authors.affiliation: Department of Public Health, CHU de Nice, Nice, France.
authors.forename: C
authors.initials: C
authors.lastname: Pradier
authors.affiliation: Hematology/Transplantation Unit, Saint Louis Hospital, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Peffault de Latour
authors.affiliation: Université de Nice-Sophia Antipolis, Nice, France.|Pediatric Hematology-Oncology Department, Hôpital l'Archet, CHU de Nice, Nice, France.
authors.forename: P-S
authors.initials: PS
authors.lastname: Rohrlich
mesh_terms: D000208:Acute Disease; D002648:Child; D018450:Disease Progression; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D015456:Leukemia, Biphenotypic, Acute / Q000401:mortality / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D017710:Lymphocyte Transfusion; D010166:Palliative Care; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome