Haploidentical hematopoietic stem cell transplantation may improve long-term survival for children with high-risk T-cell acute lymphoblastic leukemia in first complete remission. Issue 8 (20th April 2022)

• Record Type: Journal Article
• Authors: Zhang, Yongzhan; Bai, Lu; Cheng, Yifei; Lu, Aidong; Wang, Yu; Wu, Jun; Zhang, Xiaohui; Zuo, Yingxi; Xu, Lanping; Jia, Yueping; Huang, Xiaojun; Zhang, Leping
• Editors: Lyu, Peng
• Is Part Of: Chinese medical journal. Volume 135:Issue 8(2022)
• Page Start: 940
• Page End: 949
• Publication Date: 2022-04-20
• Subjects: T-cell acute lymphoblastic leukemia -- Allogeneic hematopoietic stem cell transplantation -- Haploidentical -- Minimal residual disease -- Children; Medicine -- Periodicals; Medicine, Oriental -- Periodicals; Medicine; Medicine, Oriental; Medicine; Medicine, East Asian Traditional; Periodicals; Electronic journals; 610.5
• DOI: 10.1097/CM9.0000000000001999
• Languages: English
• ISSNs: 0366-6999

Abstract

Abstract: Background: The role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with high-risk (HR) T-cell acute lymphoblastic leukemia (T-ALL) in first complete remission (CR1) is still under evaluation. Moreover, relapse is the main factor affecting survival. This study aimed to explore the effect of allo-HSCT (especially haploidentical HSCT [haplo-HSCT]) on improving survival and reducing relapse for HR childhood T-ALL in CR1 and the prognostic factors of childhood T-ALL in order to identify who could benefit from HSCT. Methods: A total of 74 newly diagnosed pediatric T-ALL patients between January 1, 2012 and June 30, 2018 were enrolled in this retrospective study. Patients were stratified into the low-risk chemotherapy cohort ( n = 16), HR chemotherapy cohort ( n = 31), and HR transplant cohort ( n = 27). Characteristics, survival outcomes, and prognostic factors of all patients were then analyzed. Results: Patient prognosis in the HR chemotherapy cohort was significantly worse than that in the low-risk chemotherapy cohort (5year overall survival [OS]: 58.5% vs. 100%, P = 0.003; 5-year event-free survival [EFS]: 54.1% vs. 83.4%, P = 0.010; 5-year cumulative incidence of relapse [CIR]: 45.2% vs. 6.3%, P = 0.011). In HR patients, allo-HSCT improved the 5-year EFS and CIR compared to that of chemotherapy (5-year EFS: 80.1% vs. 54.1%, P = 0.041; 5-year CIR: 11.6% vs. 45.2%, P = 0.006). The 5-year OS was higher in the HR transplant cohort than that in the HR chemotherapy cohort (81.0% vs. 58.5%, P = 0.084). Minimal residual disease re-emergence was an independent risk factor for 5-year OS, EFS, and CIR; age ≥10 years was an independent risk factor for OS and EFS; and high white blood cell count was an independent risk factor for EFS and CIR. Conclusion: Allo-HSCT, especially haplo-HSCT, could effectively reduce relapse of children with HR T-ALL in CR1.