TY - JOUR
T1 - Different Kinetics and Risk Factors for Isolated Extramedullary Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Children with Acute Leukemia
AU - Turkish Pediatric Bone Marrow Transplantation Study Group
AU - Hazar, Volkan
AU - Öztürk, Gülyüz
AU - Yalçın, Koray
AU - Uygun, Vedat
AU - Aksoylar, Serap
AU - Küpesiz, A.
AU - Ok Bozkaya, İkbal
AU - Karagün, Barbaros Şahin
AU - Bozkurt, Ceyhun
AU - İleri, Talia
AU - Atay, Didem
AU - Koçak, Ülker
AU - Karasu, Gülsün Tezcan
AU - Yeşilipek, Akif
AU - Gökçe, Müge
AU - Kansoy, Savaş
AU - Kintrup, Gülen Tüysüz
AU - Karakükcü, Musa
AU - Okur, Fatma Visal
AU - Ertem, Mehmet
AU - Kaya, Zühre
AU - Gürsel, Orhan
AU - Yaman, Yöntem
AU - Özbek, Namık
AU - Antmen, Bülent
AU - Tüfekçi, Özlem
AU - Albayrak, Canan
AU - Adaklı Aksoy, Başak
AU - Sezgin, Gülay
AU - Albayrak, Davut
AU - Evim, Melike Sezgin
AU - Zengin, Emine
AU - Pekpak, Esra
N1 - Publisher Copyright:
© 2021 The American Society for Transplantation and Cellular Therapy
PY - 2021/10
Y1 - 2021/10
N2 - Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most frequent cause of post-transplantation mortality. Isolated extramedullary (EM) relapse (iEMR) after HSCT is relatively rare and not well characterized, particularly in pediatric patients. We retrospectively analyzed 1527 consecutive pediatric patients with acute leukemia after allo-HSCT to study the incidence, risk factors, and outcome of iEMR compared with systemic relapse. The 5-year cumulative incidence of systemic relapse (either bone marrow [BM] only or BM combined with EMR) was 24.8%, and that of iEMR was 5.5%. The onset of relapse after allo-HSCT was significantly longer in EM sites than in BM sites (7.19 and 5.58 months, respectively; P =.013). Complete response (CR) 2+/active disease at transplantation (hazard ratio [HR], 3.1; P <.001) and prior EM disease (HR, 2.3; P =.007) were independent risk factors for iEMR. Chronic graft-versus-host disease reduced the risk of systemic relapse (HR, 0.5; P =.043) but did not protect against iEMR. The prognosis of patients who developed iEMR remained poor but was slightly better than that of patients who developed systemic relapse (3-year overall survival, 16.5% versus 15.3%; P =.089). Patients experiencing their first systemic relapse continued to have further systemic relapse, but only a minority progressed to iEMR, whereas those experiencing their iEMR at first relapse developed further systemic relapse and iEMR at approximately similar frequencies. A second iEMR was more common after a first iEMR than after a first systemic relapse (58.8% versus 13.0%; P =.001) and was associated with poor outcome. iEMR has a poor prognosis, particularly after a second relapse, and effective strategies are needed to improve outcomes.
AB - Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most frequent cause of post-transplantation mortality. Isolated extramedullary (EM) relapse (iEMR) after HSCT is relatively rare and not well characterized, particularly in pediatric patients. We retrospectively analyzed 1527 consecutive pediatric patients with acute leukemia after allo-HSCT to study the incidence, risk factors, and outcome of iEMR compared with systemic relapse. The 5-year cumulative incidence of systemic relapse (either bone marrow [BM] only or BM combined with EMR) was 24.8%, and that of iEMR was 5.5%. The onset of relapse after allo-HSCT was significantly longer in EM sites than in BM sites (7.19 and 5.58 months, respectively; P =.013). Complete response (CR) 2+/active disease at transplantation (hazard ratio [HR], 3.1; P <.001) and prior EM disease (HR, 2.3; P =.007) were independent risk factors for iEMR. Chronic graft-versus-host disease reduced the risk of systemic relapse (HR, 0.5; P =.043) but did not protect against iEMR. The prognosis of patients who developed iEMR remained poor but was slightly better than that of patients who developed systemic relapse (3-year overall survival, 16.5% versus 15.3%; P =.089). Patients experiencing their first systemic relapse continued to have further systemic relapse, but only a minority progressed to iEMR, whereas those experiencing their iEMR at first relapse developed further systemic relapse and iEMR at approximately similar frequencies. A second iEMR was more common after a first iEMR than after a first systemic relapse (58.8% versus 13.0%; P =.001) and was associated with poor outcome. iEMR has a poor prognosis, particularly after a second relapse, and effective strategies are needed to improve outcomes.
KW - Acute leukemia
KW - Children
KW - Post-transplantation relapse
UR - http://www.scopus.com/inward/record.url?scp=85111517361&partnerID=8YFLogxK
U2 - 10.1016/j.jtct.2021.06.023
DO - 10.1016/j.jtct.2021.06.023
M3 - Article
C2 - 34216791
AN - SCOPUS:85111517361
SN - 2666-6367
VL - 27
SP - 859.e1-859.e10
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 10
ER -