Transplant-related toxicity and mortality: An AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia

A. Balduzzi, M. G. Valsecchi, D. Silvestri, F. Locatelli, L. Manfredini, A. Busca, A. P. Iori, C. Messina, A. Prete, M. Andolina, F. Porta, C. Favre, S. Ceppi, G. Giorgiani, E. Lanino, A. Rovelli, F. Fagioli, C. De Fusco, R. Rondelli, C. Uderzo

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Abstract

Hematopoietic stem cell transplantation can cure high-risk acute leukemia (AL), but the occurrence of non-leukemic death is still high. The AIEOP conducted a prospective study in order to assess incidence and relationships of early toxicity and transplant-related mortality (TRM) in a pediatric population. Between 1990 and 1997 toxicities reported in eight organs (central nervous system, heart, lungs, liver, gut, kidneys, bladder, mucosa) were classified into three grades (mild, moderate, severe) and prospectively registered for 636 consecutive children who underwent autologous (216) or allogeneic (420) transplantation, either from an HLA compatible related (294), or alternative (126) donor in 13 AIEOP transplant centers. Overall, 47% of the patients are alive in CR (3-year EFS: 45.2%, s.e.: 2.1), 19% died in CR at a median of 60 days (90-day TRM: 14.3%, s.e.: 1.4), 34% relapsed. Toxicity of any organ, but mucosa and gut, was positively correlated with early death; moderate and severe toxicity to heart, lungs, liver and kidneys significantly increased early TRM, with estimated relative risks of 9.1, 5.5, 2.7 and 2.8, respectively, as compared to absent or mild toxicity. Patients with grade III-IV aGVHD experienced more than double (56% vs 19%) TRM than patients with grade 0-II aGVHD. A higher cumulative toxicity score, estimating the impact of toxicity on TRM, was significantly associated with transplantation from an alternative donor. Quantitative assessment allowed us to describe the extent to which 'grade' of toxicity and 'type' of involved organs were related to mortality and pre-transplant characteristics and yielded a prognostic score potentially useful to compare different conditioning regimens and predict probability of early death.

Original languageEnglish
Pages (from-to)93-100
Number of pages8
JournalBone Marrow Transplantation
Volume29
Issue number2
DOIs
Publication statusPublished - 2002

Fingerprint

Leukemia
Prospective Studies
Pediatrics
Transplants
Mortality
Mucous Membrane
Tissue Donors
Kidney
Lung
Liver
Hematopoietic Stem Cell Transplantation
Homologous Transplantation
Urinary Bladder
Central Nervous System
Transplantation
Incidence
Population

Keywords

  • Acute leukemia
  • Bone marrow transplantation
  • Childhood
  • Toxicity
  • Transplant related toxicity
  • Transplant-related mortality

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Balduzzi, A., Valsecchi, M. G., Silvestri, D., Locatelli, F., Manfredini, L., Busca, A., ... Uderzo, C. (2002). Transplant-related toxicity and mortality: An AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia. Bone Marrow Transplantation, 29(2), 93-100. https://doi.org/10.1038/sj.bmt.1703337

Transplant-related toxicity and mortality : An AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia. / Balduzzi, A.; Valsecchi, M. G.; Silvestri, D.; Locatelli, F.; Manfredini, L.; Busca, A.; Iori, A. P.; Messina, C.; Prete, A.; Andolina, M.; Porta, F.; Favre, C.; Ceppi, S.; Giorgiani, G.; Lanino, E.; Rovelli, A.; Fagioli, F.; De Fusco, C.; Rondelli, R.; Uderzo, C.

In: Bone Marrow Transplantation, Vol. 29, No. 2, 2002, p. 93-100.

Research output: Contribution to journalArticle

Balduzzi, A, Valsecchi, MG, Silvestri, D, Locatelli, F, Manfredini, L, Busca, A, Iori, AP, Messina, C, Prete, A, Andolina, M, Porta, F, Favre, C, Ceppi, S, Giorgiani, G, Lanino, E, Rovelli, A, Fagioli, F, De Fusco, C, Rondelli, R & Uderzo, C 2002, 'Transplant-related toxicity and mortality: An AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia', Bone Marrow Transplantation, vol. 29, no. 2, pp. 93-100. https://doi.org/10.1038/sj.bmt.1703337
Balduzzi, A. ; Valsecchi, M. G. ; Silvestri, D. ; Locatelli, F. ; Manfredini, L. ; Busca, A. ; Iori, A. P. ; Messina, C. ; Prete, A. ; Andolina, M. ; Porta, F. ; Favre, C. ; Ceppi, S. ; Giorgiani, G. ; Lanino, E. ; Rovelli, A. ; Fagioli, F. ; De Fusco, C. ; Rondelli, R. ; Uderzo, C. / Transplant-related toxicity and mortality : An AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia. In: Bone Marrow Transplantation. 2002 ; Vol. 29, No. 2. pp. 93-100.
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AU - Locatelli, F.

AU - Manfredini, L.

AU - Busca, A.

AU - Iori, A. P.

AU - Messina, C.

AU - Prete, A.

AU - Andolina, M.

AU - Porta, F.

AU - Favre, C.

AU - Ceppi, S.

AU - Giorgiani, G.

AU - Lanino, E.

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AU - Fagioli, F.

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