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Biol Blood Marrow Transplant. 2017 Sep;23(9):1523-1530. doi: 10.1016/j.bbmt.2017.05.011. Epub 2017 May 17.

Personalized Prognostic Risk Score for Long-Term Survival for Children with Acute Leukemia after Allogeneic Transplantation.

Author information

1
Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
2
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California.
5
Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.
6
Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, Pennsylvania.
7
Department of Pediatrics, Texas Transplant Institute, San Antonio, Texas.
8
Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
9
Transplante Hematopoyetico, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
10
Section of Paediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, Alberta, Canada.
11
Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
12
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
13
University of Colorado-Children's Hospital, Aurora, Colorado.
14
Division of Bone Marrow Transplant and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
15
Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina.
16
Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand.
17
Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
18
University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota.
19
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
20
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: meapen@mcw.edu.

Abstract

We studied leukemia-free (LFS) and overall survival (OS) in children with acute myeloid (AML, n = 790) and acute lymphoblastic leukemia (ALL, n = 1096) who underwent transplantation between 2000 and 2010 and who survived for at least 1 year in remission after related or unrelated donor transplantation. Analysis of patient-, disease-, and transplantation characteristics and acute and chronic graft-versus-host disease (GVHD) was performed to identify factors with adverse effects on LFS and OS. These data were used to develop risk scores for survival. We did not identify any prognostic factors beyond 4 years after transplantation for AML and beyond 3 years for ALL. Risk score for survival for AML includes age, disease status at transplantation, cytogenetic risk group, and chronic GVHD. For ALL, the risk score includes age at transplantation and chronic GVHD. The 10-year probabilities of OS for AML with good (score 0, 1, or 2), intermediate (score 3), and poor risk (score 4, 5, 6, or 7) were 94%, 87%, and 68%, respectively. The 10-year probabilities of OS for ALL were 89% and 80% for good (score 0 or 1) and poor risk (score 2), respectively. Identifying children at risk for late mortality with early intervention may mitigate some excess late mortality.

KEYWORDS:

Acute lymphoblastic leukemia; Acute myeloid leukemia; Risk score; Survival; Transplantation

PMID:
28527984
PMCID:
PMC5683075
DOI:
10.1016/j.bbmt.2017.05.011
[Indexed for MEDLINE]
Free PMC Article

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