A comparison of the outcomes of children with acute myelogenous leukemia in either first or second complete remission (CR1 vs CR2) following allogeneic hematopoietic stem cell transplantation at a single transplant center

Abstract

We reviewed 70 consecutive children with AML who received hematopoietic stem cell transplantation (HSCT) in our institution between 1994 and 2005. Forty-seven children were transplanted in CR1 and 23 were transplanted in CR2. BU/CY was the most common pretransplant conditioning regimen for CR1 patients and a TBI-based conditioning regimen was the most common regimen for CR2 patients. Most patients transplanted in CR1 (81%) received related donor HSCT, whereas most of the CR2 patients (74%) received unrelated donor HSCT. Expectedly, there was a significant increase in acute GVHD incidence in CR2 patients (40 vs 25% for grades I-II and 30 vs 10% for grades III-IV; P ¼ 0.02) and a significant increase in transplant-related mortality (38 vs 11%; P ¼ 0.01). Although the difference between 3-year EFS for CR1 and CR2 was not statistically significant, there was a significantly superior 3-year overall survival for CR1 patients (74 vs 51%; P ¼ 0.05). Children with relapsed AML who achieve and maintain remission until HSCT, have a reasonable survival, but the outcome of children receiving HSCT in CR1 remains superior.

Allogeneic Hematopoietic Cell Transplantation in First Remission Abrogates Poor Outcomes Associated with High-Risk Pediatric Acute Myeloid Leukemia

“…The median time to neutrophil engraftment for HR patients was 22 (range, 2–38) days compared to 21 (14–26) days for SR patients (p=0.44). Twenty-seven of the 32 patients who received UCB grafts engrafted by day 42 post-HCT, compared to all 18 recipients of BM and PBSC grafts (88%, 95% CI 73–96% vs. 100%; p<0.01).…”

Consequent and intensified relapse therapy improved survival in pediatric AML: results of relapse treatment in 379 patients of three consecutive AML-BFM trials

“…9,20,21 In the era of graft engineering and improved methods of immunosuppression, most groups have abandoned auto-SCT. Our retrospective analysis included data of 26 patients who underwent auto-SCT in CR2, mostly from former East-German centers that had favored this approach.…”

Impact on long-term OS of conditioning regimen in allogeneic BMT for children with AML in first CR: TBI+CY versus BU+CY: a report from the Société Française de Greffe de Moelle et de Thérapie Cellulaire

“…However, including those in North America, some groups still continue using TBI-based conditioning regimen. 12,13 Then, we conducted a retrospective study to analyze the impact of conditioning regimen on the longterm OS of children who underwent HSCT for AML in CR1. We report the results regarding patients o18 years who received allogeneic HSCT from either sibling or alternative donor in France from 1980 to 2004 after myeloablative TBI-based conditioning regimen or Bu-based conditioning regimen for AML in CR1.…”