Haploidentical vs. HLA-matched donor hematopoietic stem-cell transplantation for pediatric patients with acute lymphoblastic leukemia in second remission: A collaborative retrospective study of the Spanish Group for Bone Marrow Transplantation in Children (GETMON/GETH) and the Spanish Childhood Relapsed ALL Board (ReALLNet).
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Moreno Celia, Ramos-Elbal Eduardo, Velasco Pablo, Aguilar Yurena, Gonzáález Martínez Berta, Fuentes Carolina, Molinos Águeda, Guerra-García Pilar, Palomo Pilar, Verdu Jaime, Adán Pedroso Rosa María, Vagace José Manuel, López-Duarte Mónica, Regueiro Alexandra, Tasso María, Dapena José Luis, Salinas José Antonio, Navarro Samuel, Bautista Francisco, Lassaletta Álvaro, Lendínez Francisco, Rives Susana, Pascual Antonia, Rodríguez Antonia, Pérez-Hurtado José María, Fernández José María, Pérez-Martínez Antonio, González-Vicent Marta, Díaz de Heredia Cristina, Fuster José Luis
Аннотация
METHODS: We compared outcomes of children with acute lymphoblastic leukemia (ALL) undergoing SCT in second complete remission (CR2) from haploidentical (n = 25) versus HLA-matched donor (n = 51).
RESULTS: Patients were equally distributed across both groups according to age, immunophenotype, time to and site of relapse, relapse risk-group allocation, and minimal residual disease (MRD) before SCT. Incidence of graft failure, acute graft versus host disease (GVHD), and other early complications did not differ between both groups. We found no differences in overall survival (58.7% versus 59.5%; p = .8), leukemia free survival (LFS) (48% versus 36.4%; p = .5), event free survival (40% versus 34.4%; p = .69), cumulative incidence (CI) of subsequent relapse (28% versus 40.9%; p = .69), treatment related mortality (24% versus 23.6%; p = .83), CI of cGVHD (4.5% versus 18.7%; p = .2), and chronic GVHD-free and leukemia-free survival (44% versus 26.3%; p = .3) after haploidentical donor SCT. Chronic GVHD (HR = 0.09; p=.02) had protective impact, and MRD ≥ 0.01% before SCT (HR = 2.59; p=.01) had unfavorable impact on LFS.
DISCUSSION: These results support the role of haploidentical donor SCT in children with ALL in CR2.