Pediatric leukemias: second allogeneic HSCT may be an effective salvage therapy

  • TCT 2020
  • 20 Feb 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • For children with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or myelodysplastic syndrome (MDS) who have relapsed after an allogeneic hematopoietic stem cell transplant (HSCT), a second transplant may serve as successful salvage therapy.

Why this matters

  • Disease relapse is the most common cause of mortality after HSCT, and 20%-30% of children who receive allogeneic HSCT are likely to experience a relapse.

Study design

  • The study included children with ALL, AML, or MDS who experienced disease relapse following their first HSCT (n=221).
  • Funding: St. Jude’s Children’s Research Hospital; American Society of Hematology; American Society for Transplantation and Cellular Therapy.

Key results

  • Of the patients with relapse, 60% received some chemotherapy or supportive care, 13% received donor lymphocyte infusion alone, and 28% received a second HSCT.
  • The 3-year OS for patients who received a second HSCT was significantly higher than for those who did not (28% vs 4%).
  • In a multivariable analysis, factors associated with better OS included: 
    • Longer interval from first HSCT to relapse (P<.001>
    • Eligible to receive a second HSCT (P<.001 and>
    • Receiving HSCT in the current decade (P<.001>

Limitations

  • Retrospective design.