Takashi Taga1, Yoshitaka Murakami2, Ken Tabuchi3, Souichi Adachi4, Daisuke Tomizawa5, Yasuko Kojima6, Koji Kato7, Kazutoshi Koike8, Katsuyoshi Koh9, Ryosuke Kajiwara10, Kazuko Hamamoto11, Hiromasa Yabe12, Keisei Kawa13, Yoshiko Atsuta14,15, Kazuko Kudo16. 1. Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan. 2. Department of Medical Statistics, Toho University, Tokyo, Japan. 3. Division of Pediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 4. Department of Human Health Science, Kyoto University, Kyoto, Japan. 5. Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan. 6. Department of Pediatrics, Toho University Omori Hospital, Tokyo, Japan. 7. Department of Pediatric Hematology/Oncology, Nagoya First Red Cross Hospital, Nagoya, Japan. 8. Department of Hematology/Oncology, Ibaraki Children's Hospital, Mito, Japan. 9. Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan. 10. Department of Pediatrics, Yokohama City University, Yokohama, Japan. 11. Department of Pediatrics, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan. 12. Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan. 13. Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan. 14. Department of Healthcare Administration, Nagoya University, Nagoya, Japan. 15. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya University, Nagoya, Japan. 16. Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.
Abstract
BACKGROUND: In children with acute myeloid leukemia (AML), hematopoietic stem cell transplantation (HSCT) in first remission is indicated for patients with a relatively high risk of relapse. Second HSCT is a curative option; however, few reports have been published about a second HSCT in children for AML with posttransplantation relapse. PROCEDURE: Using the database provided by the Japanese Society of Hematopoietic Cell Transplantation, we analyzed 46 children with AML who underwent a second allogeneic HSCT after achieving a second remission. RESULTS: The median duration from the first to second HSCT was 20 months, and the source of the second HSCT was related bone marrow (BM) in 22, related peripheral blood in 6, unrelated BM in 14, and unrelated cord blood in 4 patients. Twenty-five children eventually died of the following causes: progressive disease in 14 and transplant-related toxicities in 9. The 5-year overall survival rate was 41.7 ± 7.7%. An interval of less than 24 months between the first and second HSCT was a significant poor prognostic factor. CONCLUSIONS: Children with AML who experience a relapse after HSCT in first remission have a good chance of survival with a second HSCT if a second remission is achieved.
BACKGROUND: In children with acute myeloid leukemia (AML), hematopoietic stem cell transplantation (HSCT) in first remission is indicated for patients with a relatively high risk of relapse. Second HSCT is a curative option; however, few reports have been published about a second HSCT in children for AML with posttransplantation relapse. PROCEDURE: Using the database provided by the Japanese Society of Hematopoietic Cell Transplantation, we analyzed 46 children with AML who underwent a second allogeneic HSCT after achieving a second remission. RESULTS: The median duration from the first to second HSCT was 20 months, and the source of the second HSCT was related bone marrow (BM) in 22, related peripheral blood in 6, unrelated BM in 14, and unrelated cord blood in 4 patients. Twenty-five children eventually died of the following causes: progressive disease in 14 and transplant-related toxicities in 9. The 5-year overall survival rate was 41.7 ± 7.7%. An interval of less than 24 months between the first and second HSCT was a significant poor prognostic factor. CONCLUSIONS:Children with AML who experience a relapse after HSCT in first remission have a good chance of survival with a second HSCT if a second remission is achieved.