Different kinetics and risk factors for ısolated extramedullary relapse after allogeneic hematopoietic stem cell transplantation in children with acute leukemia
Yükleniyor...
Tarih
2021
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Elsevier
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most frequent cause ofpost-transplantation mortality. Isolated extramedullary (EM) relapse (iEMR) after HSCT is relatively rare and notwell characterized, particularly in pediatric patients. We retrospectively analyzed 1527 consecutive pediatricpatients with acute leukemia after allo-HSCT to study the incidence, risk factors, and outcome of iEMR comparedwith systemic relapse. The 5-year cumulative incidence of systemic relapse (either bone marrow [BM] only or BMcombined with EMR) was 24.8%, and that of iEMR was 5.5%. The onset of relapse after allo-HSCT was significantlylonger in EM sites than in BM sites (7.19 and 5.58 months, respectively;P= .013). Complete response (CR) 2+/active disease at transplantation (hazard ratio [HR], 3.1;P<.001) and prior EM disease (HR, 2.3;P= .007) were independent risk factors for iEMR. Chronic graft-versus-host disease reduced the risk of systemic relapse (HR, 0.5;P= .043) but did not protect against iEMR. The prognosis of patients who developed iEMR remained poor but wasslightly better than that of patients who developed systemic relapse (3-year overall survival, 16.5% versus 15.3%;P= .089). Patients experiencing theirfirst systemic relapse continued to have further systemic relapse, but only aminority progressed to iEMR, whereas those experiencing their iEMR atfirst relapse developed further systemicrelapse and iEMR at approximately similar frequencies. A second iEMR was more common after afirst iEMR thanafter afirst systemic relapse (58.8% versus 13.0%;P= .001) and was associated with poor outcome. iEMR has apoor prognosis, particularly after a second relapse, and effective strategies are needed to improve outcomes.© 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.
Açıklama
Anahtar Kelimeler
Acute Leukemia, Post-Transplantation Relapse, Children
Kaynak
Transplantation and Cellular Therapy
WoS Q Değeri
Q1
Scopus Q Değeri
Q1
Cilt
27
Sayı
10
Künye
Hazar, V., Öztürk, G., Yalçın, K., Uygun, V., Aksoylar, S., Küpesiz, A., ... Turkish Pediatric Bone Marrow Transplantation Study Group. (2021). Different kinetics and risk factors for isolated extramedullary relapse after allogeneic hematopoietic stem cell transplantation in children with acute leukemia. Transplantation and Cellular Therapy, 27(10), 859-e1.
