Prognosis of haploidentical hematopoietic stem cell transplantation in non-infant children with t(v;11q23)/MLL-rearranged B-cell acute lymphoblastic leukemia. (April 2020)

• Record Type: Journal Article
• Authors: Bai, Lu; Cheng, Yi-fei; Lu, Ai-dong; Suo, Pan; Wang, Yu; Zuo, Ying-xi; Yan, Chen-hua; Wu, Jun; Jia, Yue-ping; Sun, Yu-qian; Chen, Yu-hong; Chen, Huan; Liu, Kai-yan; Han, Wei; Xu, Lan-ping; Wang, Jing-bo; Tang, Xiang-feng; Chen, Hui-ren; Zhang, Le-ping; Huang, Xiao-jun
• Is Part Of: Leukemia research. Volume 91(2020)
• Publication Date: 2020-04
• Subjects: Haploidentical hematopoietic stem cell transplantation -- Non-infant -- MLL-rearranged -- B-cell acute lymphoblastic leukemia; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2020.106333
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: The high relapse rate of MLL-rearranged leukemia accounts for the poor prognosis. Hematopoietic stem cell transplantation may reduce recurrence and improve outcomes. Transplantation at first complete remission is an independent protective factor. Abstract: B-cell acute lymphoblastic leukemia (B-ALL) with MLL-rearrangements (MLL-r) is rare in pediatric patients (aged >1 year), and optimal treatment strategies remain unclear. This study aimed to retrospectively evaluate the clinical characteristics, outcomes, and effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) of 37 non-infant children with t(v;11q23)/MLL-r B-ALL. Their 4-year overall survival (OS), event-free survival (EFS), and cumulative incidence of relapse (CIR) were 69.8 %, 58.2 %, and 39.1 %, respectively, and differed significantly between patients receiving allo-HSCT (18/19 cases received haploidentical [haplo]-HSCT) at the first complete remission (HSCT at CR1, n = 19; 87.4 %, 89.5 % and 5.3 %) and those continuing consolidation therapy (Non-HSCT at CR1, n = 18; 52.2 %, 25.9 %, and 74.1 %, respectively), and the p values were 0.022, <0.001 and <0.001, respectively. Of the 13 patients experiencing relapse during consolidation chemotherapy, the five continuing with chemotherapy only died within 44 months, and the eight patients opting for allo-HSCT after CR2 had a 4-year OS of 57.1 %. Multivariate analysis revealed HSCT at CR1 as the only independent protective factor for OS, EFS, and CIR. The present results indicate that allo-HSCT (especially haplo-HSCT) at CR1 may decrease the relapse rate and improve the prognosis of non-infant children with t(v;11q23)/MLL-r B-ALL.