Takeaway
- Transplant-related mortality (TRM) is the main cause of death in children treated with haematopoietic stem cell transplantation for therapy-related acute myeloid leukaemia (t-AML).
Why this matters
- The authors suggest the high incidence of TRM was caused by the heavily pre-treated status of the patients.
- Potential measures such as reduction of salvage chemotherapy after achieving remission and a careful choice of conditioning regimen may be helpful in reducing TRM.
- The authors are planning to prospectively examine if a reduced toxicity rather than a reduced intensity conditioning regimen could reduce TRM while preserving anti-leukaemic activity.
Key results
- Median time from the original diagnosis to the diagnosis of t-AML was 3.8 yrs.
- Majority (28 patients) received a graft from an unrelated donor.
- Overall, 28 patients received myeloablative regimens and 6 received reduced intensity conditioning.
- Survival outcome was available for 35 patients.
- At median follow up of 7.3 yrs, 23 patients had died, giving a survival rate of 43%.
- 13 of the 23 (56%) died from TRM and 10 (44%) died from disease relapse, giving an overall TRM rate of 37% and a relapse rate of 29%.
- Potential variables affecting survival were as follows t-AML secondary to solid tumour vs haematological/lymphoid malignancy; donor source; risk cytogenetics; and conditioning regimens.
Study design
- Multi-centre retrospective study of 36 children who were diagnosed with t-AML and received HSCT in a dedicated Joint Accreditation Committee-ISCT & EBMT (JACIE) accredited paediatric UK transplant centre.
- Funding: none specified.
Limitations
- Survival model statistical analysis was not possible due to limited number of patients.
References
References