Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia

Troy C. Lund; Kwang Woo Ahn; Heather R. Tecca; Megan V. Hilgers; Hisham Abdel-Azim; Allistair Abraham; Miguel Angel Diaz; Sherif M. Badawy; Larisa Broglie; Valerie Brown; Christopher C. Dvorak; Marta Gonzalez-Vicent; Hasan Hashem; Robert J. Hayashi; David A. Jacobsohn; Michael W. Kent; Chi kong Li; Steven P. Margossian; Paul L. Martin; Parinda Mehta; Kasiani Myers; Richard Olsson; Kristin Page; Michael A. Pulsipher; Peter J. Shaw; Angela R. Smith; Brandon M. Triplett; Michael R. Verneris; Mary Eapen

doi:10.1016/j.bbmt.2018.09.016

Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia

Troy C. Lund, Kwang Woo Ahn, Heather R. Tecca, Megan V. Hilgers, Hisham Abdel-Azim, Allistair Abraham, Miguel Angel Diaz, Sherif M. Badawy, Larisa Broglie, Valerie Brown, Christopher C. Dvorak, Marta Gonzalez-Vicent, Hasan Hashem, Robert J. Hayashi, David A. Jacobsohn, Michael W. Kent, Chi kong Li, Steven P. Margossian, Paul L. Martin, Parinda MehtaKasiani Myers, Richard Olsson, Kristin Page, Michael A. Pulsipher, Peter J. Shaw, Angela R. Smith, Brandon M. Triplett, Michael R. Verneris, Mary Eapen^*

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Children with acute leukemia who relapse after hematopoietic cell transplantation (HCT) have few therapeutic options. We studied 251 children and young adults with acute myelogenous or lymphoblastic leukemia who underwent a second HCT for relapse after their first HCT. The median age at second HCT was 11 years, and the median interval between first and second HCT was 17 months. Most of the patients (n = 187; 75%) were in remission, received a myeloablative conditioning regimen (n = 157; 63%), and underwent unrelated donor HCT (n = 230; 92%). The 2-year probability of leukemia-free survival (LFS) was 33% after transplantation in patients in remission, compared with 19% after transplantation in patients not in remission (P =.02). The corresponding 8-year probabilities were 24% and 10% (P =.003). A higher rate of relapse contributed to the difference in LFS. The 2-year probability of relapse after transplantation was 42% in patients in remission and 56% in those in relapse (P =.05). The corresponding 8-year probabilities were 49% and 64% (P =.04). These data extend the findings of others showing that patients with a low disease burden are more likely to benefit from a second transplantation. Late relapse led to a 10% decrement in LFS beyond the second year after second HCT. This differs from first HCT, in which most relapses occur within 2 years after HCT.

Original language	English (US)
Pages (from-to)	301-306
Number of pages	6
Journal	Biology of Blood and Marrow Transplantation
Volume	25
Issue number	2
DOIs	https://doi.org/10.1016/j.bbmt.2018.09.016
State	Accepted/In press - Jan 1 2018

Funding

Financial disclosure: The CIBMTR is supported primarily by Public Health Service Grant U24CA076518 from the National Cancer Institute , National Heart, Lung and Blood Institute and National Institute of Allergy and Infectious Diseases ; Grant U10HL069294 from the National Heart, Lung and Blood Institute and National Cancer Institute , and Contract HHSH250201200016C from the Health Resources and Services Administration, Department of Health and Human Services . The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, Health Resources and Services Administration, or any other agency of the US Government. Financial disclosure: The CIBMTR is supported primarily by Public Health Service Grant U24CA076518 from the National Cancer Institute, National Heart, Lung and Blood Institute and National Institute of Allergy and Infectious Diseases; Grant U10HL069294 from the National Heart, Lung and Blood Institute and National Cancer Institute, and Contract HHSH250201200016C from the Health Resources and Services Administration, Department of Health and Human Services. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, Health Resources and Services Administration, or any other agency of the US Government.

Keywords

relapse acute leukemia second transplant

ASJC Scopus subject areas

Hematology
Transplantation

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10.1016/j.bbmt.2018.09.016

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Lund, T. C., Ahn, K. W., Tecca, H. R., Hilgers, M. V., Abdel-Azim, H., Abraham, A., Diaz, M. A., Badawy, S. M., Broglie, L., Brown, V., Dvorak, C. C., Gonzalez-Vicent, M., Hashem, H., Hayashi, R. J., Jacobsohn, D. A., Kent, M. W., Li, C. K., Margossian, S. P., Martin, P. L., ... Eapen, M. (Accepted/In press). Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia. Biology of Blood and Marrow Transplantation, 25(2), 301-306. https://doi.org/10.1016/j.bbmt.2018.09.016

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title = "Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia",

abstract = "Children with acute leukemia who relapse after hematopoietic cell transplantation (HCT) have few therapeutic options. We studied 251 children and young adults with acute myelogenous or lymphoblastic leukemia who underwent a second HCT for relapse after their first HCT. The median age at second HCT was 11 years, and the median interval between first and second HCT was 17 months. Most of the patients (n = 187; 75%) were in remission, received a myeloablative conditioning regimen (n = 157; 63%), and underwent unrelated donor HCT (n = 230; 92%). The 2-year probability of leukemia-free survival (LFS) was 33% after transplantation in patients in remission, compared with 19% after transplantation in patients not in remission (P =.02). The corresponding 8-year probabilities were 24% and 10% (P =.003). A higher rate of relapse contributed to the difference in LFS. The 2-year probability of relapse after transplantation was 42% in patients in remission and 56% in those in relapse (P =.05). The corresponding 8-year probabilities were 49% and 64% (P =.04). These data extend the findings of others showing that patients with a low disease burden are more likely to benefit from a second transplantation. Late relapse led to a 10% decrement in LFS beyond the second year after second HCT. This differs from first HCT, in which most relapses occur within 2 years after HCT.",

keywords = "relapse acute leukemia second transplant",

author = "Lund, {Troy C.} and Ahn, {Kwang Woo} and Tecca, {Heather R.} and Hilgers, {Megan V.} and Hisham Abdel-Azim and Allistair Abraham and Diaz, {Miguel Angel} and Badawy, {Sherif M.} and Larisa Broglie and Valerie Brown and Dvorak, {Christopher C.} and Marta Gonzalez-Vicent and Hasan Hashem and Hayashi, {Robert J.} and Jacobsohn, {David A.} and Kent, {Michael W.} and Li, {Chi kong} and Margossian, {Steven P.} and Martin, {Paul L.} and Parinda Mehta and Kasiani Myers and Richard Olsson and Kristin Page and Pulsipher, {Michael A.} and Shaw, {Peter J.} and Smith, {Angela R.} and Triplett, {Brandon M.} and Verneris, {Michael R.} and Mary Eapen",

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Lund, TC, Ahn, KW, Tecca, HR, Hilgers, MV, Abdel-Azim, H, Abraham, A, Diaz, MA, Badawy, SM, Broglie, L, Brown, V, Dvorak, CC, Gonzalez-Vicent, M, Hashem, H, Hayashi, RJ, Jacobsohn, DA, Kent, MW, Li, CK, Margossian, SP, Martin, PL, Mehta, P, Myers, K, Olsson, R, Page, K, Pulsipher, MA, Shaw, PJ, Smith, AR, Triplett, BM, Verneris, MR & Eapen, M 2018, 'Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia', Biology of Blood and Marrow Transplantation, vol. 25, no. 2, pp. 301-306. https://doi.org/10.1016/j.bbmt.2018.09.016

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T1 - Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia

AU - Lund, Troy C.

AU - Ahn, Kwang Woo

AU - Tecca, Heather R.

AU - Hilgers, Megan V.

AU - Abdel-Azim, Hisham

AU - Abraham, Allistair

AU - Diaz, Miguel Angel

AU - Badawy, Sherif M.

AU - Broglie, Larisa

AU - Brown, Valerie

AU - Dvorak, Christopher C.

AU - Gonzalez-Vicent, Marta

AU - Hashem, Hasan

AU - Hayashi, Robert J.

AU - Jacobsohn, David A.

AU - Kent, Michael W.

AU - Li, Chi kong

AU - Margossian, Steven P.

AU - Martin, Paul L.

AU - Mehta, Parinda

AU - Myers, Kasiani

AU - Olsson, Richard

AU - Page, Kristin

AU - Pulsipher, Michael A.

AU - Shaw, Peter J.

AU - Smith, Angela R.

AU - Triplett, Brandon M.

AU - Verneris, Michael R.

AU - Eapen, Mary

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Children with acute leukemia who relapse after hematopoietic cell transplantation (HCT) have few therapeutic options. We studied 251 children and young adults with acute myelogenous or lymphoblastic leukemia who underwent a second HCT for relapse after their first HCT. The median age at second HCT was 11 years, and the median interval between first and second HCT was 17 months. Most of the patients (n = 187; 75%) were in remission, received a myeloablative conditioning regimen (n = 157; 63%), and underwent unrelated donor HCT (n = 230; 92%). The 2-year probability of leukemia-free survival (LFS) was 33% after transplantation in patients in remission, compared with 19% after transplantation in patients not in remission (P =.02). The corresponding 8-year probabilities were 24% and 10% (P =.003). A higher rate of relapse contributed to the difference in LFS. The 2-year probability of relapse after transplantation was 42% in patients in remission and 56% in those in relapse (P =.05). The corresponding 8-year probabilities were 49% and 64% (P =.04). These data extend the findings of others showing that patients with a low disease burden are more likely to benefit from a second transplantation. Late relapse led to a 10% decrement in LFS beyond the second year after second HCT. This differs from first HCT, in which most relapses occur within 2 years after HCT.

AB - Children with acute leukemia who relapse after hematopoietic cell transplantation (HCT) have few therapeutic options. We studied 251 children and young adults with acute myelogenous or lymphoblastic leukemia who underwent a second HCT for relapse after their first HCT. The median age at second HCT was 11 years, and the median interval between first and second HCT was 17 months. Most of the patients (n = 187; 75%) were in remission, received a myeloablative conditioning regimen (n = 157; 63%), and underwent unrelated donor HCT (n = 230; 92%). The 2-year probability of leukemia-free survival (LFS) was 33% after transplantation in patients in remission, compared with 19% after transplantation in patients not in remission (P =.02). The corresponding 8-year probabilities were 24% and 10% (P =.003). A higher rate of relapse contributed to the difference in LFS. The 2-year probability of relapse after transplantation was 42% in patients in remission and 56% in those in relapse (P =.05). The corresponding 8-year probabilities were 49% and 64% (P =.04). These data extend the findings of others showing that patients with a low disease burden are more likely to benefit from a second transplantation. Late relapse led to a 10% decrement in LFS beyond the second year after second HCT. This differs from first HCT, in which most relapses occur within 2 years after HCT.

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Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia

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