Use of Allogeneic Hematopoietic Stem-Cell Transplantation Based on Minimal Residual Disease Response Improves Outcomes for Children With Relapsed Acute Lymphoblastic Leukemia in the Intermediate-Risk Group

Eckert, Cornelia; Henze, Günter; Seeger, K.; Hagedorn, Nikola; Mann, Georg; Panzer‐Grümayer, Renate; Peters, Christina; Klingebiel, Thomas; Borkhardt, Arndt; Schrappe, Martin; Schrauder, André; Escherich, Gabriele; Šrámková, Lucie; Niggli, Felix; Hitzler, Johann; Stackelberg, Arend von

doi:10.1200/jco.2012.48.5680

Cited by 155 publications

(124 citation statements)

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“…4 Over the last two decades, the reported relapse rates have been 15-20% [1][2][3]5,6 in the developed countries and the overall survival after relapse approximately 40-70%, depending on the follow-up time and the risk groups involved. [7][8][9][10][11][12] Since 1992, all children aged one year and over diagnosed with pre-B and T-cell ALL in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) have been treated according to a common Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL protocol. Children with relapsed ALL, on the other hand, have been treated heterogeneously since there has not been a common NOPHO ALL relapse protocol.…”

Section: Introductionmentioning

confidence: 99%

Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome

et al. 2015

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R elapse is the main reason for treatment failure in childhood acute lymphoblastic leukemia. Despite improvements in the up-front therapy, survival after relapse is still relatively poor, especially for high-risk relapses. The aims of this study were to assess outcomes following acute lymphoblastic leukemia relapse after common initial Nordic Society of Paediatric Haematology and Oncology protocol treatment; to validate currently used risk stratifications, and identify additional prognostic factors for overall survival. Altogether, 516 of 2735 patients (18.9%) relapsed between 1992 and 2011 and were included in the study. There were no statistically significant differences in outcome between the up-front protocols or between the relapse protocols used, but an improvement over time was observed. The 5-year overall survival for patients relapsing in the period 2002-2011 was 57.5±3.4%, but 44.7±3.2% (P<0.001) if relapse occurred in the period 1992-2001. Factors independently predicting mortality after relapse included short duration of first remission, bone marrow involvement, age ten years or over, unfavorable cytogenetics, and Down syndrome. T-cell immunophenotype was not an independent prognostic factor unless in combination with hyperleukocytosis at diagnosis. The outcome for early combined pre-B relapses was unexpectedly poor (5-year overall survival 38.0±10.6%), which supports the notion that these patients need further risk adjustment. Although survival outcomes have improved over time, the development of novel approaches is urgently needed to increase survival in relapsed childhood acute lymphoblastic leukemia. Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome

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Section: Introductionmentioning

confidence: 99%

Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome

et al. 2015

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“…[3][4][5][6] Over the past decades, the practice of allo-SCT has considerably evolved. [7][8][9][10][11][12][13] New sources of hematopoietic stem cells, such as peripheral blood stem cells and umbilical cord blood (UCB), 14,15 have become available. The advent of reduced intensity conditioning (RIC) regimens has provided a curative option to patients who otherwise would not have undergone allo-SCT.…”

Section: Introductionmentioning

confidence: 99%

Improvement of overall survival after allogeneic hematopoietic stem cell transplantation for children and adolescents: a three-decade experience of a single institution

Brissot

Rialland

Cahu

et al. 2015

Bone Marrow Transplant

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International audienceAllogeneic stem cell transplantation (allo-SCT) has become an essential component of the treatment for a variety of diseases in pediatric patients. During the past decades, advances in the transplant technology, availability of hematopoietic stem cells and supportive care not only have resulted in improved outcomes, but also have expanded the transplant options. However, these features have been studied mainly in adult populations. This investigation analyzed changes in patient profile, transplantation, graft characteristics and outcome among 250 children and adolescent patients who received allo-SCT in a single center between 1983 and 2010. In the 2000–2010, compared with the 1983–1999 period, a significantly higher 5-year overall survival (64% versus 52%, P=0.03) was observed together with a significant decrease of non-relapse mortality (27% versus 9%, P=0.0002). The progression-free survival was comparable between the two periods (49% versus 57%; P=0.17). The 5-year cumulative incidence of relapse was 24% between 1983 and 1999, and 34% between 2000 and 2010 (P=0.08). Major advances in supportive care practice have been made over the past decade, resulting in a significant survival benefit for the pediatric population undergoing allo-SCT. However, post-transplant relapse remains the leading cause of failure of this therapeutic approach, and preventing relapse represents a major challenge toda

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“…Using these prognostic factors, treatment consists of re-induction chemotherapy (4 weeks) and determination of response. For patients with early relapse recommendations for Stem Cell Transplantation (SCT) using allogeneic or matched unrelated donors are considered [58][59][60]. MRD should be minimal prior to SCT, even if it requires additional chemotherapy as higher residual disease portents SCT failure and recurrence of disease [61][62][63].…”

Section: Treatment Of Relapsed Pallmentioning

confidence: 99%

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2017

HTIJ

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ClassificationEarly classification schema for pALL relied on criteria using the French-American-British (FAB) system, based on morphology and other patient characteristics. The FAB system is no longer AbstractProgress in the understanding and treatment of pediatric acute lymphoblastic leukemia over the past 60 years has been remarkable and it is now expected that 80-85% of children diagnosed will be cured of this disease. This review article discusses risk factors, classification, presentation, risk groups, treatment, outcome, and long-term complications of therapy. Pediatric cancer studies serve as a model for national and international group cooperation to treat uncommon diseases.

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Use of Allogeneic Hematopoietic Stem-Cell Transplantation Based on Minimal Residual Disease Response Improves Outcomes for Children With Relapsed Acute Lymphoblastic Leukemia in the Intermediate-Risk Group

Cited by 155 publications

References 28 publications

Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome

Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome

Improvement of overall survival after allogeneic hematopoietic stem cell transplantation for children and adolescents: a three-decade experience of a single institution

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