Favorable outcome for infant acute lymphoblastic leukemia after hematopoietic stem cell transplantation

David A. Jacobsohn*, Brad Hewlett, Elaine Morgan, William Tse, Reggie E. Duerst, Morris Kletzel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Infants with acute lymphoblastic leukemia (ALL) have a poor prognosis when treated with standard chemotherapy. A subset of these infants, particularly those with mixed-lineage leukemia (MLL) rearrangements, has a high likelihood of relapse. Hematopoietic stem cell transplantation (HSCT) performed early in first remission may improve outcome. We present the results of 16 patients with infant ALL who were treated with HSCT in first remission. Six patients were ≤6 months of age at diagnosis, 11 had an initial white blood cell count of >50000/μL, and all patients with determinable cytogenetics had a high-risk karyotype [t(4:11) abnormality or other MLL rearrangement]. All patients received 150 cGy of total body irradiation for 8 doses (1200 cGy). Fifteen of 16 patients received etoposide at 1000 mg/m2 as a continuous infusion over 24 hours and cyclophosphamide at 60 mg/kg/d for 3 days. Eight patients received HSCT from an HLA-identical sibling, and 8, from unrelated cord blood. Twelve (75%) patients remain long-term survivors (median follow-up, 4.7 years). Two patients, 1 of whom had minimal residual disease at HSCT, died after relapse following HSCT. Two patients died of transplant-related causes. The HSCT was well tolerated; 15 patients achieved neutrophil engraftment at a median of 16 days. Acute and chronic graft-versus-host disease were minimal in these patients. These results support the use of HSCT in the treatment of infant ALL, especially when used as consolidation in first remission. The risk of relapse seems to be decreased with this approach. Further work is being performed to determine the long-term effects from this therapy.

Original languageEnglish (US)
Pages (from-to)999-1005
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume11
Issue number12
DOIs
StatePublished - Dec 2005

Keywords

  • Infant ALL
  • Leukemia
  • Pediatric
  • Stem cell transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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