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Biol Blood Marrow Transplant. 2019 Apr 17. pii: S1083-8791(19)30237-X. doi: 10.1016/j.bbmt.2019.04.014. [Epub ahead of print]

Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukemia in Adolescents and Young Adults.

Author information

1
Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, The University of Tokyo, Tokyo, Japan. Electronic address: mayusuzuki-tky@umin.ac.jp.
2
Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan; Graduate School of Public Health, St Luke's International University, Tokyo, Japan.
3
Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.
4
Central Japan Cord Blood Bank, Seto, Japan.
5
Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan.
6
Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.
7
Department of Pediatrics, National Kyusyu Cancer Center, Fukuoka, Japan.
8
Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan.
9
Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
10
Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Japan.
11
Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan.
12
Department of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan.
13
Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan.
14
Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
15
Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan.
16
Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan.

Abstract

Hematologic stem cell transplantation (HSCT) is the most potent consolidation therapy for high-risk acute lymphoblastic leukemia (ALL), but their outcomes and complications in adolescent and young adult (AYA) patients remain unclear. We compared outcomes after HSCT for ALL among children (age 1 to 9 years; n = 607), adolescents (age 10 to 19 years; n = 783), and young adults (age 20 to 29 years old, n = 603), based on Japanese nationwide registry data. The 5-year overall survival (OS) rate among AYA patients was worse than that of children, at 64% (95% confidence interval [CI], 60% to 68%). In the AYA, the 5-year treatment-related mortality (TRM) after HSCT was 19% (95% CI, 16% to 22%), significantly higher than that in younger patients. The most common cause of TRM in the AYA was infection. The relapse rate was not different across the 3 age groups. When focusing on older adolescents (age 15 to 19 years), there was no difference in outcomes between those treated in pediatric centers and those treated in adult centers. In conclusion, the AYA had a greater risk of nonrelapse death than younger patients, and infection was the most common cause. Further optimization is required for HSCT in AYAs with ALL.

KEYWORDS:

Acute lymphoblastic leukemia; Adolescent and young adult; Hematologic stem cell transplantation

PMID:
31002992
DOI:
10.1016/j.bbmt.2019.04.014

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