Different Kinetics and Risk Factors for Isolated Extramedullary Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Children with Acute Leukemia

被引：5

作者：

Hazar, Volkan ^{[1
]}

Ozturk, Gulyuz ^{[2
]}

Yalcin, Koray ^{[3
]}

Uygun, Vedat ^{[4
]}

Aksoylar, Serap ^{[5
]}

Kupesiz, A. ^{[6
]}

Bozkaya, Ikbal Ok ^{[7
]}

Karagun, Barbaros Sahin ^{[8
]}

Bozkurt, Ceyhun ^{[9
]}

Ileri, Talia ^{[10
]}

Atay, Didem ^{[2
]}

Kocak, Ulker ^{[11
]}

Karasu, Gulsun Tezcan ^{[12
]}

Yesilipek, Akif ^{[13
]}

Gokce, Muge ^{[14
]}

Kansoy, Savas ^{[5
]}

Kintrup, Gulen Tuysuz ^{[6
]}

Karakukcu, Musa ^{[15
]}

Okur, Fatma Visal ^{[16
]}

Ertem, Mehmet ^{[10
]}

Kaya, Zuhre ^{[11
]}

Gursel, Orhan ^{[17
]}

Yaman, Yontem ^{[18
]}

Ozbek, Namik ^{[7
]}

Antmen, Bulent ^{[8
]}

Tufekci, Ozlem ^{[19
]}

Albayrak, Canan ^{[20
]}

Aksoy, Basak Adakli ^{[9
]}

Sezgin, Gulay ^{[21
]}

Albayrak, Davut ^{[22
]}

Evim, Melike Sezgin ^{[23
]}

Zengin, Emine ^{[24
]}

Pekpak, Esra ^{[25
]}

机构：

[1] Medstar Yildiz Hosp, Antalya, Turkey

[2] Acibadem Univ, Acibadem Altunizade Hosp, Fac Med, Istanbul, Turkey

[3] Bahcesehir Univ, Fac Med, Med Pk Goztepe Hosp, Istanbul, Turkey

[4] Istinye Univ, Fac Med, Med Pk Antalya Hosp, Antalya, Turkey

[5] Ege Univ, Fac Med, Izmir, Turkey

[6] Akdeniz Univ, Fac Med, Antalya, Turkey

[7] Univ Hlth Sci, Ankara City Hosp, Ankara, Turkey

[8] Acibadem Univ, Adana Hosp, Fac Med, Adana, Turkey

[9] Altinbas Univ, Fac Med, Med Pk Bahcelievler Hosp, Istanbul, Turkey

[10] Ankara Univ Ankara, Fac Med, Ankara, Turkey

[11] Gazi Univ, Fac Med, Ankara, Turkey

[12] Med Pk Goztepe Hosp, Istanbul, Turkey

[13] Med Pk Antalya Hosp, Antalya, Turkey

[14] Yuzuncu Yil Univ, GOP Hosp, Fac Med, Istanbul, Turkey

[15] Erciyes Univ, Fac Med, Kayseri, Turkey

[16] Hacettepe Univ, Fac Med, Ankara, Turkey

[17] Univ Hlth Sci, GATA Hosp, Ankara, Turkey

[18] Istanbul Medipol Univ, Istanbul, Turkey

[19] Dokuz Eylul Univ, Fac Med, Izmir, Turkey

[20] On Dokuz Mayis Univ, Fac Med, Samsun, Turkey

[21] Cukurova Univ, Fac Med, Adana, Turkey

[22] Med Pk Samsun Hosp, Samsun, Turkey

[23] Uludag Univ, Fac Med, Bursa, Turkey

[24] Kocaeli Univ, Fac Med, Kocaeli, Turkey

[25] Gaziantep Univ, Fac Med, Gaziantep, Turkey

来源：

TRANSPLANTATION AND CELLULAR THERAPY | 2021年 / 27卷 / 10期

关键词：

Acute leukemia; Post-transplantation relapse; Children; BONE-MARROW-TRANSPLANTATION; ACUTE MYELOGENOUS LEUKEMIA; MINIMAL RESIDUAL DISEASE; TOTAL-BODY IRRADIATION; ACUTE MYELOID-LEUKEMIA; PROGNOSIS; AML;

D O I：

10.1016/j.jtct.2021.06.023

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

引用

页码：859.e1 / 859.e10

页数：10

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