Outcome after failure of allogeneic hematopoietic stem cell transplantation in children with acute leukemia: a study by the société Francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

Date publication

mai 2017

Journal

Bone marrow transplantation

Auteurs

Membres identifiés du Cancéropôle Est :
Dr POCHON Cécile

Tous les auteurs :
Roux C, Tifratene K, Socié G, Galambrun C, Bertrand Y, Rialland F, Jubert C, Pochon C, Paillard C, Sirvent A, Nelken B, Vannier JP, Freycon C, Beguin Y, Raus N, Yakoub-Agha I, Mohty M, Dalle JH, Michel G, Pradier C, Peffault de Latour R, Rohrlich PS

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/28112748

Résumé

Allogeneic hematopoietic stem cell transplantation (SCT) contributes to improved outcome in childhood acute leukemia (AL). However, therapeutic options are poorly defined in the case of post-transplantation relapse. We aimed to compare treatment strategies in 334 consecutive children with acute leukemia relapse or progression after SCT in a recent 10-year period. Data could be analyzed in 288 patients (157 ALL, 123 AML and 8 biphenotypic AL) with a median age of 8.16 years at transplantation. The median delay from first SCT to relapse or progression was 182 days. The treatment consisted of chemotherapy alone (n=108), chemotherapy followed by second SCT (n=70), supportive/palliative care (n=67), combination of chemotherapy and donor lymphocyte infusion (DLI; n=30), or isolated reinfusion of donor lymphocytes (DLI; n=13). The median OS duration after relapse was 164 days and differed according to therapy: DLI after chemotherapy=385 days, second allograft=391 days, chemotherapy=174 days, DLI alone=140 days, palliative care=43 days. A second SCT or a combination of chemotherapy and DLI yielded similar outcome (hazard ratio (HR)=0.85, P=0.53) unlike chemotherapy alone (HR=1.43 P=0.04), palliative care (HR=4.24, P<0.0001) or isolated DLI (HR=1,94, P<0.04). Despite limitations in this retrospective setting, strategies including immunointervention appear superior to other approaches, mostly in AML.

Mots clés

Acute Disease, Child, Disease Progression, Hematopoietic Stem Cell Transplantation, methods, Humans, Leukemia, mortality, Leukemia, Biphenotypic, Acute, mortality, Leukemia, Myeloid, Acute, mortality, Lymphocyte Transfusion, Palliative Care, Precursor Cell Lymphoblastic Leukemia-Lymphoma, mortality, Retrospective Studies, Survival Rate, Transplantation, Homologous, Treatment Failure, Treatment Outcome

Référence

Bone Marrow Transplant. 2017 May;52(5):678-682