Hematopoietic stem cell transplantation for children with high-risk acute lymphoblastic leukemia in first complete remission: a report from the AIEOP registry
Franca Fagioli,
Paola Quarello,
Marco Zecca,
Edoardo Lanino,
Carla Rognoni,
Adriana Balduzzi,
Chiara Messina,
Claudio Favre,
Roberto Foà,
Mimmo Ripaldi,
Sergio Rutella,
Giuseppe Basso,
Arcangelo Prete,
Franco Locatelli
Affiliations
Franca Fagioli
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Paola Quarello
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
Marco Zecca
Department of Pediatric Onco-Hematology, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy
Edoardo Lanino
Department of Pediatric Hematology Oncology, G. Gaslini Institute, Genova, Italy
Carla Rognoni
Department of Industrial and Information Engineering, University of Pavia, Pavia, Italy;Center for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
Adriana Balduzzi
Department of Pediatric Hematology, San Gerardo Hospital, Monza, Italy
Chiara Messina
Department of Pediatric Hematology and Oncology, University of Padova, Padova, Italy
Claudio Favre
Department of Pediatrics, University of Pisa, Pisa, Italy
Roberto Foà
Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Roma, Italy
Mimmo Ripaldi
BMT Unit, Department of Pediatric Hemato-Oncology, Santobono-Pausilipon Hospital, Napoli, Italy
Sergio Rutella
Department of Pediatric Hematology-Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children’s Hospital, Roma, Italy
Giuseppe Basso
Department of Pediatrics, Laboratory of Hematology-Oncology, University of Padova, Padova, Italy
Arcangelo Prete
Pediatric Oncology and Hematology Unit “Lalla Seragnoli”, Department of Pediatrics, University of Bologna Sant’Orsola-Malpighi Hospital, Bologna, Italy
Franco Locatelli
Department of Pediatric Hematology-Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children’s Hospital, Roma, Italy;University of Pavia, Pavia, Italy
Children with high-risk acute lymphoblastic leukemia in first complete remission can benefit from allogeneic hematopoietic stem cell transplantation. We analyzed the outcome of 211 children with high-risk acute lymphoblastic leukemia in first complete remission who were given an allogeneic transplant between 1990 and 2008; the outcome of patients who, despite having an indication for transplantation and a suitable donor, did not receive the allograft for different reasons in the same time period was not analyzed. Sixty-nine patients (33%) were transplanted between 1990 and 1999, 58 (27%) between 2000 and 2005, and 84 (40%) between 2005 and 2008. A matched family donor was employed in 138 patients (65%) and an unrelated donor in 73 (35%). The 10-year probabilities of overall and disease-free survival were 63.4% and 61%, respectively. The 10-year cumulative incidences of transplantation-related mortality and relapse were 15% and 24%, respectively. After 1999, no differences in either disease-free survival or transplant-related mortality were observed in patients transplanted from unrelated or matched family donors. In multivariate analysis, grade IV acute graft-versus-host disease was an independent factor associated with worse disease-free survival. By contrast, grade I acute graft-versus-host disease and age at diagnosis between 1 and 9 years were favorable prognostic variables. Our study, not intended to evaluate whether transplantation is superior to chemotherapy for children with acute lymphoblastic leukemia in first complete remission and high-risk features, shows that the allograft cured more than 60% of these patients; in the most recent period, the outcome of recipients of grafts from matched family and unrelated donors was comparable.
