Factors Associated with Long-Term Risk of Relapse after Unrelated Cord Blood Transplantation in Children with Acute Lymphoblastic Leukemia in Remission.
Abstract
For pediatric patients with acute lymphoblastic leukemia (ALL), relapse is an important
cause of treatment failure after unrelated cord blood transplant (UCBT). Compared
with other donor sources, relapse is similar or even reduced after UCBT despite less
graft-versus-host disease (GVHD). We performed a retrospective analysis to identify
risk factors associated with the 5-year cumulative incidence of relapse after UCBT.
In this retrospective, registry-based study, we examined the outcomes of 640 children
(<18 years) with ALL in first complete remission (CR1; n = 257, 40%) or second complete
remission (CR2; n = 383, 60%) who received myeloablative conditioning followed by
a single-unit UCBT from 2000 to 2012. Most received antithymocyte globulin (88%) or
total body irradiation (TBI; 69%), and cord blood grafts were primarily mismatched
at 1 (50%) or 2<sup>+</sup> (34%) HLA loci. Considering patients in CR1, the rates
of 5-year overall survival (OS), leukemia-free survival (LFS), and relapse were 59%,
52%, and 23%, respectively. In multivariate analysis (MVA), acute GVHD (grades II
to IV) and TBI protected against relapse. In patients in CR2, rates of 5-year OS,
LFS, and the cumulative incidence of relapse were 46%, 44%, and 28%, respectively.
In MVA, longer duration from diagnosis to UCBT (≥30 months) and TBI were associated
with decreased relapse risk. Importantly, receiving a fully HLA matched graft was
a strong risk factor for increased relapse in MVA. An exploratory analysis of all
640 patients supported the important association between the presence of acute GVHD
and less relapse but also demonstrated an increased risk of nonrelapse mortality.
In conclusion, the impact of GVHD as a graft-versus-leukemia marker is evident in
pediatric ALL after UCBT. Strategies that promote graft-versus-leukemia while harnessing
GVHD should be further investigated.
Type
Journal articleSubject
HumansRecurrence
Disease-Free Survival
Transplantation Conditioning
Cord Blood Stem Cell Transplantation
Survival Rate
Risk Factors
Time Factors
Adolescent
Child
Child, Preschool
Infant
Female
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Unrelated Donors
Allografts
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https://hdl.handle.net/10161/24590Published Version (Please cite this version)
10.1016/j.bbmt.2017.04.015Publication Info
Page, Kristin M; Labopin, Myriam; Ruggeri, Annalisa; Michel, Gerard; Diaz de Heredia,
Cristina; O'Brien, Tracey; ... Rocha, Vanderson (2017). Factors Associated with Long-Term Risk of Relapse after Unrelated Cord Blood Transplantation
in Children with Acute Lymphoblastic Leukemia in Remission. Biology of blood and marrow transplantation : journal of the American Society for
Blood and Marrow Transplantation, 23(8). pp. 1350-1358. 10.1016/j.bbmt.2017.04.015. Retrieved from https://hdl.handle.net/10161/24590.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Joanne Kurtzberg
Jerome S. Harris Distinguished Professor of Pediatrics
Dr. Kurtzberg conducts both clinical and laboratory-based translational research
efforts, all involving various aspects of normal and malignant hematopoiesis. In the
laboratory, her early work focused on studies determining the mechanisms that regulate
the choice between the various pathways of differentiation available to the pluripotent
hematopoietic stem cell. Her laboratory established a CD7+ cell line, DU.528, capable
of multilineage differentiation as well as self-renewal, and subse
Kristin Marie Page
Assistant Professor of Pediatrics
Stem cell transplantation and/or cellular therapies can be used to treat a variety
of pediatric diseases including malignancies such as leukemia, lymphoma and myelodysplastic
syndrome in addition to certain non-malignant conditions (such as immune deficiencies,
inherited metabolic diseases, hemoglobinopathies, and bone marrow failure syndromes).
As the Director of the Pediatric Transplant and Cellular Therapy Survivorship Clinic,
my goal is optimize the care of survivors of pediatric stem cell t
Jesse David Troy
Assistant Professor of Biostatistics & Bioinformatics
I am a biostatistician supporting research in cell therapies and regenerative medicine
at the Duke Marcus Center for Cellular Cures, and research studies in cancer therapeutics
and palliative care at the Duke Cancer Institute. I also teach biostatistics in the
Master of Biostatistics program and the <a href="
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