Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children

Maria Gabelli, Marco Zecca, Chiara Messina, Elisa Carraro, Barbara Buldini, Attilio Maria Rovelli, Franca Fagioli, Alice Bertaina, Edoardo Lanino, Claudio Favre, Marco Rabusin, Arcangelo Prete, Mimmo Ripaldi, Walter Barberi, Fulvio Porta, Maurizio Caniglia, Stella Santarone, Paolo D'Angelo, Giuseppe Basso, Franco Locatelli

Research output: Contribution to journalArticle

Abstract

Relapse of acute lymphoblastic leukemia (ALL) may occur in extramedullary sites, mainly central nervous system (CNS) and testis. Optimal post-remissional treatment for isolated extramedullary relapse (IEMR) is still controversial. We collected data of children treated with hematopoietic stem cell transplantation (HSCT) for ALL IEMR from 1990 to 2015 in Italy. Among 281 patients, 167 had a relapse confined to CNS, 73 to testis, 14 to mediastinum, and 27 to other organs. Ninety-seven patients underwent autologous HSCT, 79 received allogeneic HSCT from a matched family donor, 75 from a matched unrelated donor, and 30 from an HLA-haploidentical donor. The 10-year overall survival was 56% and was not influenced by gender, ALL blast immune-phenotype, age, site of relapse, duration of first remission, and type of HSCT. In multivariable analysis, the only prognostic factors were disease status at HSCT and year of transplantation. Patients transplanted in third or subsequent complete remission (CR) had a risk of death 2.3 times greater than those in CR2. Children treated after 2000 had half the risk of death than those treated before that year. Our results suggest that both autologous and allogeneic HSCT may be considered for the treatment of pediatric ALL IEMR after the achievement of CR2.

Original languageEnglish
JournalBone Marrow Transplantation
DOIs
Publication statusE-pub ahead of print - Jun 13 2018

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Hematopoietic Stem Cell Transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Testis
Central Nervous System
Tissue Donors
Unrelated Donors
Mediastinum
Italy
Transplantation
Pediatrics
Phenotype
Survival
Therapeutics

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Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children. / Gabelli, Maria; Zecca, Marco; Messina, Chiara; Carraro, Elisa; Buldini, Barbara; Rovelli, Attilio Maria; Fagioli, Franca; Bertaina, Alice; Lanino, Edoardo; Favre, Claudio; Rabusin, Marco; Prete, Arcangelo; Ripaldi, Mimmo; Barberi, Walter; Porta, Fulvio; Caniglia, Maurizio; Santarone, Stella; D'Angelo, Paolo; Basso, Giuseppe; Locatelli, Franco.

In: Bone Marrow Transplantation, 13.06.2018.

Research output: Contribution to journalArticle

Gabelli, M, Zecca, M, Messina, C, Carraro, E, Buldini, B, Rovelli, AM, Fagioli, F, Bertaina, A, Lanino, E, Favre, C, Rabusin, M, Prete, A, Ripaldi, M, Barberi, W, Porta, F, Caniglia, M, Santarone, S, D'Angelo, P, Basso, G & Locatelli, F 2018, 'Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children', Bone Marrow Transplantation. https://doi.org/10.1038/s41409-018-0259-5
Gabelli, Maria ; Zecca, Marco ; Messina, Chiara ; Carraro, Elisa ; Buldini, Barbara ; Rovelli, Attilio Maria ; Fagioli, Franca ; Bertaina, Alice ; Lanino, Edoardo ; Favre, Claudio ; Rabusin, Marco ; Prete, Arcangelo ; Ripaldi, Mimmo ; Barberi, Walter ; Porta, Fulvio ; Caniglia, Maurizio ; Santarone, Stella ; D'Angelo, Paolo ; Basso, Giuseppe ; Locatelli, Franco. / Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children. In: Bone Marrow Transplantation. 2018.
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AU - Gabelli, Maria

AU - Zecca, Marco

AU - Messina, Chiara

AU - Carraro, Elisa

AU - Buldini, Barbara

AU - Rovelli, Attilio Maria

AU - Fagioli, Franca

AU - Bertaina, Alice

AU - Lanino, Edoardo

AU - Favre, Claudio

AU - Rabusin, Marco

AU - Prete, Arcangelo

AU - Ripaldi, Mimmo

AU - Barberi, Walter

AU - Porta, Fulvio

AU - Caniglia, Maurizio

AU - Santarone, Stella

AU - D'Angelo, Paolo

AU - Basso, Giuseppe

AU - Locatelli, Franco

PY - 2018/6/13

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N2 - Relapse of acute lymphoblastic leukemia (ALL) may occur in extramedullary sites, mainly central nervous system (CNS) and testis. Optimal post-remissional treatment for isolated extramedullary relapse (IEMR) is still controversial. We collected data of children treated with hematopoietic stem cell transplantation (HSCT) for ALL IEMR from 1990 to 2015 in Italy. Among 281 patients, 167 had a relapse confined to CNS, 73 to testis, 14 to mediastinum, and 27 to other organs. Ninety-seven patients underwent autologous HSCT, 79 received allogeneic HSCT from a matched family donor, 75 from a matched unrelated donor, and 30 from an HLA-haploidentical donor. The 10-year overall survival was 56% and was not influenced by gender, ALL blast immune-phenotype, age, site of relapse, duration of first remission, and type of HSCT. In multivariable analysis, the only prognostic factors were disease status at HSCT and year of transplantation. Patients transplanted in third or subsequent complete remission (CR) had a risk of death 2.3 times greater than those in CR2. Children treated after 2000 had half the risk of death than those treated before that year. Our results suggest that both autologous and allogeneic HSCT may be considered for the treatment of pediatric ALL IEMR after the achievement of CR2.

AB - Relapse of acute lymphoblastic leukemia (ALL) may occur in extramedullary sites, mainly central nervous system (CNS) and testis. Optimal post-remissional treatment for isolated extramedullary relapse (IEMR) is still controversial. We collected data of children treated with hematopoietic stem cell transplantation (HSCT) for ALL IEMR from 1990 to 2015 in Italy. Among 281 patients, 167 had a relapse confined to CNS, 73 to testis, 14 to mediastinum, and 27 to other organs. Ninety-seven patients underwent autologous HSCT, 79 received allogeneic HSCT from a matched family donor, 75 from a matched unrelated donor, and 30 from an HLA-haploidentical donor. The 10-year overall survival was 56% and was not influenced by gender, ALL blast immune-phenotype, age, site of relapse, duration of first remission, and type of HSCT. In multivariable analysis, the only prognostic factors were disease status at HSCT and year of transplantation. Patients transplanted in third or subsequent complete remission (CR) had a risk of death 2.3 times greater than those in CR2. Children treated after 2000 had half the risk of death than those treated before that year. Our results suggest that both autologous and allogeneic HSCT may be considered for the treatment of pediatric ALL IEMR after the achievement of CR2.

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JO - Bone Marrow Transplantation

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