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Prognosis of relapse after hematopoietic cell transplant (HCT) for treatment of leukemia or myelodysplastic syndrome (MDS) in children

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Abstract

We studied 232 consecutive children transplanted between 1990 and 2011 with relapse after first hematopoietic cell transplant (HCT). Kaplan–Meier survival and hazard ratios for mortality were calculated for factors known at time of relapse using Cox proportional hazards models. The median (range) age at time of first HCT was 10.9 (0.5–20.9) years, time to relapse was 6.1 (0.2–89.5) months after HCT, and age at relapse was 11.7 (0.7–23.6) years. The 3-year overall survival (OS) after relapse was 13% (95% confidence interval (CI): 9%, 18%).The median (range) follow-up for the 18 surviving patients was 7.2 (3.0–24.4) years after relapse. The remaining 214 died after a median of 3 months (0.02–190.4). OS was not significantly different for patients with ALL as compared to AML. Fifty-one patients proceeded to second transplant of whom nine survive. Factors associated with improved survival included late relapse (>12 months), ALL in first CR at the time of first transplant and chemotherapy-based first conditioning regimens. These results can be used to counsel patients at the time of relapse after first transplant and as a baseline for comparison as to the effectiveness of newer therapies which are greatly needed for treatment of post-transplant relapse.

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Acknowledgements

MB is supported through NHLBI RO1 HL121568–04, Alex’s Lemonade Stand Foundation Biotherapeutic Impact Grant, Leukemia and Lymphoma Society Translational Research Program 6519–17, Cookies for Kids Cancer and ACCR SU2C Innovative Research Grant 14–17. C.D. is supported by K23HL077446 and RC2HL101844. AW is supported by NHLBI P01 HL 122173–01 and NHLBI P01 HL 036444–30.

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  1. Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA

    Ann Dahlberg, Wendy Leisenring, Marie Bleakley, Soheil Meshinchi, K. Scott Baker, Corinne Summers, Brandon Hadland, Colleen Delaney, Kanwaldeep Mallhi, Lauri Burroughs, Paul Carpenter & Ann Woolfrey

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  1. Ann Dahlberg
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Correspondence to Ann Dahlberg.

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Dahlberg, A., Leisenring, W., Bleakley, M. et al. Prognosis of relapse after hematopoietic cell transplant (HCT) for treatment of leukemia or myelodysplastic syndrome (MDS) in children. Bone Marrow Transplant 54, 1337–1345 (2019). https://doi.org/10.1038/s41409-019-0438-z

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