Risk factors and timing of relapse after allogeneic transplantation in pediatric ALL: for whom and when should interventions be tested? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-09

AUTHORS

M A Pulsipher, B Langholz, D A Wall, K R Schultz, N Bunin, W Carroll, E Raetz, S Gardner, R K Goyal, J Gastier-Foster, M Borowitz, D Teachey, S A Grupp

ABSTRACT

We previously showed that minimal residual disease (MRD) detection pre-hematopoietic cell transplant (HCT) and acute GvHD (aGvHD) independently predicted risk of relapse in pediatric ALL. In this study we further define risk by assessing timing of relapse and the effects of leukemia risk category and post-HCT MRD. By multivariate analysis, pre-HCT MRD <0.1% and aGvHD by day +55 were associated with decreased relapse and improved event-free survival (EFS). Intermediate leukemia risk status predicted decreased relapse, and improved EFS and overall survival (OS). Patients with pre-HCT MRD ⩾0.1% who did not develop aGvHD compared with those with MRD <0.1% who did develop aGvHD had much worse survival (2 years EFS 18% vs 71%; P=0.001, 2 years OS 46 vs 74%; P=0.04). Patients with pre-HCT MRD <0.1% who did not experience aGvHD had higher rates of relapse than those who did develop aGvHD (40% vs 13%; P= 0.008). Post-HCT MRD led to a substantial increase in relapse risk (HR=4.5, P<0.01). Patients at high risk of relapse can be defined after transplant using leukemia risk category, presence of MRD pre or post HCT, and occurrence of aGvHD. An optimal window to initiate intervention to prevent relapse occurs between day +55 and +200 after HCT. More... »

PAGES

1173

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/bmt.2015.103

DOI

http://dx.doi.org/10.1038/bmt.2015.103

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1044211884

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25961775


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