Abstract
Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach). If this was not feasible, low-dose chemotherapy and donor lymphocyte infusions (LDCHT+DLI) were offered (non-transplant approach). A total of 23 patients suffered a post-transplant relapse. Eight patients received HDCHT/SIT, followed by haploidentical SCT in 7/8. Ten received LDCHT+DLI. The eight patients treated with a second transplant and the ten treated with the non-transplant approach had a 4-year overall survival of 56% and 40%, respectively (P=0.232). Prerequisites for successful treatment of post-transplant relapse by either a second transplant or experimental non-transplant approaches are good clinical condition and the capacity to achieve haematological remission by the induction treatment element.
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Acknowledgements
We thank the LOEWE Center for Cell and Gene Therapy Frankfurt, which is funded by the Hessian Ministry of Higher Education, Research and the Arts, funding reference number: III L 4-518/17.004 (2013).
Author contributions
Conception and design: PB and TEK. Referral and treatment of patients: PB, TEK, JS, AJ, AMW, ER, SB, TK, MD, JF and JO. Data analysis and interpretation: PB, AMW, HK, ES-M, RB, SH, CC, MB, VP, MM and EU. Manuscript writing: AMW, PB and ES-M. Final approval of the manuscript: all authors.
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Willasch, A., Salzmann-Manrique, E., Krenn, T. et al. Treatment of relapse after allogeneic stem cell transplantation in children and adolescents with ALL: the Frankfurt experience. Bone Marrow Transplant 52, 201–208 (2017). https://doi.org/10.1038/bmt.2016.224
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DOI: https://doi.org/10.1038/bmt.2016.224
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