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Improvement over time in outcome for children with acute lymphoblastic leukemia in second remission given hematopoietic stem cell transplantation from unrelated donors

Leukemia volume 16, pages 2228–2237 (2002)Cite this article

Abstract

Aims of this study were to verify whether reduction in transplant-related mortality (TRM) of children with acute lymphoblastic leukemia (ALL) in second complete remission (CR) given allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated volunteers has occurred over time and to investigate the role of other variables on the probabilities of relapse, TRM and event-free survival (EFS). We compared results obtained in 26 children given HSCT before January 1998 with those of 37 patients transplanted beyond that date. In all donor–recipient pairs, histocompatibility was determined by serology for HLA-A and -B antigens and by high-resolution DNA typing for DRB1 antigen. High-resolution molecular typing of HLA class I antigens was employed in 20 of the 37 children transplanted more recently. Probability of both acute and chronic GVHD was comparable in the two groups of patients. In multivariate analysis, children transplanted before January 1998, those with T-lineage ALL and those experiencing grade II–IV acute GVHD had a higher relative risk of TRM at 6 months after transplantation. Relapse rate was unfavorably affected by a time interval between diagnosis and relapse <30 months. The 2-year probability of EFS for children transplanted before and after 1 January 1998 was 27% (10–44) and 58% (42–75), respectively (P = 0.02), this difference remaining significant in multivariate analysis. EFS of unrelated donor HSCT in children with ALL in second CR has improved in the last few years, mainly due to a decreased TRM. This information is of value for counseling of patients with relapsed ALL.

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Acknowledgements

This work has been partly supported by grants from AIRC (Associazione Italiana Ricerca sul Cancro), CNR (Consiglio Nazionale delle Ricerche), MURST (Ministero dell'Università e della Ricerca Scientifica e Tecnologica) and IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico S Matteo to FL. We are indebted to Geoff Hale for having kindly provided the monoclonal antibody Campath-1G.

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Authors and Affiliations

  1. Oncoematologia Pediatrica, IRCCS Policlinico San Matteo, Università di Pavia, Italy

    F Locatelli, M Zecca, F Bonetti & G Giorgiani

  2. Clinica Pediatrica, Università di Padova, Italy

    C Messina

  3. Clinica Pediatrica, Ospedale Sant'Orsola, Università di Bologna, Italy

    R Rondelli & A Pession

  4. Divisione di Ematologia e Oncologia, Istituto G Gaslini, Genova, Italy

    E Lanino

  5. Registro Italiano Donatori di Midollo Osseo, Ospedali Galliera, Genova, Italy

    N Sacchi

  6. Clinica Pediatrica, Ospedale Nuovo S Gerardo, Monza, Italy

    C Uderzo & V Conter

  7. Clinica Pediatrica, Università di Torino, Italy

    F Fagioli

  8. Clinica Pediatrica, Università di Pisa, Italy

    C Favre

  9. Clinica Pediatrica, Spedali Civili, Università di Brescia, Italy

    F Porta

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Locatelli, F., Zecca, M., Messina, C. et al. Improvement over time in outcome for children with acute lymphoblastic leukemia in second remission given hematopoietic stem cell transplantation from unrelated donors. Leukemia 16, 2228–2237 (2002). https://doi.org/10.1038/sj.leu.2402690

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