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Bone Marrow Transplant. 2017 Feb;52(2):201-208. doi: 10.1038/bmt.2016.224. Epub 2016 Sep 19.

Treatment of relapse after allogeneic stem cell transplantation in children and adolescents with ALL: the Frankfurt experience.

Author information

1
Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
2
Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany.
3
Department of Pediatric Oncology, University of Mannheim, Mannheim, Germany.
4
Department of Pediatric Hematology and Oncology, Children's Hospital of Johannes Gutenberg University, Mainz, Germany.

Abstract

Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach). If this was not feasible, low-dose chemotherapy and donor lymphocyte infusions (LDCHT+DLI) were offered (non-transplant approach). A total of 23 patients suffered a post-transplant relapse. Eight patients received HDCHT/SIT, followed by haploidentical SCT in 7/8. Ten received LDCHT+DLI. The eight patients treated with a second transplant and the ten treated with the non-transplant approach had a 4-year overall survival of 56% and 40%, respectively (P=0.232). Prerequisites for successful treatment of post-transplant relapse by either a second transplant or experimental non-transplant approaches are good clinical condition and the capacity to achieve haematological remission by the induction treatment element.

PMID:
27643863
DOI:
10.1038/bmt.2016.224
[Indexed for MEDLINE]

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