Faculty Collaboration Database

Allogeneic hematopoietic cell transplantation in children with relapsed acute lymphoblastic leukemia isolated to the central nervous system. Biol Blood Marrow Transplant 2008 Jun;14(6):685-92

Date

05/21/2008

Pubmed ID

18489994

DOI

10.1016/j.bbmt.2008.03.011

Scopus ID

2-s2.0-43449139122 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is the standard of care for pediatric patients with early medullary relapse of acute lymphoblastic leukemia (ALL). Most patients with isolated central nervous system (CNS) relapse have good outcomes when treated with intrathecal and systemic chemotherapy followed by irradiation to the neuroaxis. However, the role of HCT remains unclear for those patients with early isolated CNS relapse (<18 months) or who had high risk disease at diagnosis. We therefore compared the HCT outcomes of 116 children treated at the University of Minnesota from 1991 to 2006 with relapsed ALL involving the CNS alone (CNS, n = 14), the bone marrow alone (BM, n = 85), or both bone marrow and CNS (BM + CNS, n = 17). There were no significant differences among groups in age at diagnosis or transplant, length of first complete remission (CR1), remission status (CR2 versus >or=CR3), graft source, or preparative regimen. The incidence of acute GVHD was similar between groups. Patients with isolated CNS relapse had the lowest cumulative incidence of mortality following transplant (CNS: 0%, BM: 19%, BM + CNS: 29%, P = .03) and relapse (CNS: 0% BM: 30%, BM + CNS: 12%, at 2 years, P = .01) and highest leukemia-free survival (CNS: 91%, BM: 35%, BM + CNS: 46%, P < .01) at 5 years. Risk factors for poor survival were: T cell leukemia or BCR-ABL gene rearrangement, history of marrow relapse, and receipt of HLA-mismatched marrow. These data support the use of allogeneic HCT in the treatment of children with poor prognosis isolated CNS relapse.

Author List

Harker-Murray PD, Thomas AJ, Wagner JE, Weisdorf D, Luo X, DeFor TE, Verneris MR, Dusenbery KE, MacMillan ML, Tolar J, Baker KS, Orchard PJ

Author

Paul D. Harker-Murray MD, PhD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Age Factors
Antineoplastic Combined Chemotherapy Protocols
Bone Marrow Transplantation
Central Nervous System
Child
Child, Preschool
Combined Modality Therapy
Cord Blood Stem Cell Transplantation
Cranial Irradiation
Female
Hematopoietic Stem Cell Transplantation
Humans
Infant
Leukemic Infiltration
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis
Radiotherapy, Adjuvant
Recurrence
Remission Induction
Retrospective Studies
Risk Factors
Survival Analysis
Transplantation Conditioning
Transplantation, Homologous
Treatment Outcome