Outcomes after HLA-matched sibling transplantation or chemotherapy in children with acute lymphoblastic leukemia in a second remission after an isolated central nervous system relapse: A collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research

M. Eapen, M. J. Zhang, M. Devidas, E. Raetz, Julio Barredo, A. K. Ritchey, K. Godder, S. Grupp, V. A. Lewis, K. Malloy, W. L. Carroll, S. M. Davies, B. M. Camitta

Research output: Contribution to journalArticle

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Abstract

In children with acute lymphoblastic leukemia (ALL) with isolated central nervous system (CNS) relapse and a human leucocyte antigen (HLA)-matched sibling, the optimal treatment after attaining second remission is unknown. We compared outcomes in 149 patients enrolled on chemotherapy trials and 60 HLA-matched sibling transplants, treated in 1990-2000. All patients achieved a second complete remission. Groups were similar, except the chemotherapy recipients were younger at diagnosis, less likely to have T-cell ALL and had longer duration (≥18 months) first remission. To adjust for time-to-transplant bias, left-truncated Cox's regression models were constructed. Relapse rates were similar after chemotherapy and transplantation. In both treatment groups, relapse rates were higher in older children (11-17 years; RR 2.81, P=0.002) and shorter first remission (<18 months; RR 3.89, P<0.001). Treatment-related mortality rates were higher after transplantation (RR 4.28, P=0.001). The 8-year probabilities of leukemia-free survival adjusted for age and duration of first remission were similar after chemotherapy with irradiation and transplantation (66 and 58%, respectively). In the absence of an advantage for one treatment option over another, the data support use of either intensive chemotherapy with irradiation or HLA-matched sibling transplantation with total body irradiation containing conditioning regimen for children with ALL in second remission after an isolated CNS relapse.

Original languageEnglish
Pages (from-to)281-286
Number of pages6
JournalLeukemia
Volume22
Issue number2
DOIs
StatePublished - Feb 1 2008

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HLA Antigens
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Siblings
Central Nervous System
Transplantation
Bone Marrow
Transplants
Recurrence
Drug Therapy
Research
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Whole-Body Irradiation
Therapeutics
Proportional Hazards Models
Leukemia
Survival
Mortality

ASJC Scopus subject areas

  • Hematology
  • Cancer Research

Cite this

Outcomes after HLA-matched sibling transplantation or chemotherapy in children with acute lymphoblastic leukemia in a second remission after an isolated central nervous system relapse : A collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research. / Eapen, M.; Zhang, M. J.; Devidas, M.; Raetz, E.; Barredo, Julio; Ritchey, A. K.; Godder, K.; Grupp, S.; Lewis, V. A.; Malloy, K.; Carroll, W. L.; Davies, S. M.; Camitta, B. M.

In: Leukemia, Vol. 22, No. 2, 01.02.2008, p. 281-286.

Research output: Contribution to journalArticle

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abstract = "In children with acute lymphoblastic leukemia (ALL) with isolated central nervous system (CNS) relapse and a human leucocyte antigen (HLA)-matched sibling, the optimal treatment after attaining second remission is unknown. We compared outcomes in 149 patients enrolled on chemotherapy trials and 60 HLA-matched sibling transplants, treated in 1990-2000. All patients achieved a second complete remission. Groups were similar, except the chemotherapy recipients were younger at diagnosis, less likely to have T-cell ALL and had longer duration (≥18 months) first remission. To adjust for time-to-transplant bias, left-truncated Cox's regression models were constructed. Relapse rates were similar after chemotherapy and transplantation. In both treatment groups, relapse rates were higher in older children (11-17 years; RR 2.81, P=0.002) and shorter first remission (<18 months; RR 3.89, P<0.001). Treatment-related mortality rates were higher after transplantation (RR 4.28, P=0.001). The 8-year probabilities of leukemia-free survival adjusted for age and duration of first remission were similar after chemotherapy with irradiation and transplantation (66 and 58{\%}, respectively). In the absence of an advantage for one treatment option over another, the data support use of either intensive chemotherapy with irradiation or HLA-matched sibling transplantation with total body irradiation containing conditioning regimen for children with ALL in second remission after an isolated CNS relapse.",
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