A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIES
Introduction: Relapse of a malignant hematological disease after allogeneic HCT is associated with poor survival and may not be treated with a curative intent. However, a second HCT (HCT2) may achieve durable remission. Objective: To determine the outcomes of pediatric patients who received a HCT2 f...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Hematology, Transfusion and Cell Therapy |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2531137923011574 |
| _version_ | 1797654916869652480 |
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| author | MF Cardoso G Zamperlini CNM Breviglieri R Gouveia VC Ginani JF Marques LL Quintino LDS Domingues MGAD Matos A Seber |
| author_facet | MF Cardoso G Zamperlini CNM Breviglieri R Gouveia VC Ginani JF Marques LL Quintino LDS Domingues MGAD Matos A Seber |
| author_sort | MF Cardoso |
| collection | DOAJ |
| description | Introduction: Relapse of a malignant hematological disease after allogeneic HCT is associated with poor survival and may not be treated with a curative intent. However, a second HCT (HCT2) may achieve durable remission. Objective: To determine the outcomes of pediatric patients who received a HCT2 for relapsed malignant hematological diseases. Casuistic and method: Review of the medical records of pediatric patients who underwent a HCT2 for relapsed malignant hematological diseases in two institutions from 2013 to 2023. OS was estimated using Kaplan-Meier survival analysis. The conventional HCT Comorbidity index (HCT-CI) was calculated for all patients (http://www.hctci.org/Home/Calculator) categorized in < or ≥ 2. Results: Nineteen patients with a median age of 10 years (range, 2–17) underwent HCT2 for B-ALL (n = 8), T-ALL (n = 2), AML (n = 5), CML-BC (n = 2), MDS (n = 1) and JMML (n = 1). Donor types were unrelated (n = 4), haploidentical (n = 11), and unrelated cord-blood (n = 4). Donors were different at HCT2 in all patients and all haploidentical HCT2 used the other haplotype. All nineteen patients received myeloablative conditioning, and 52% (n = 10) were in remission at HCT2. The median remission duration after HCT1 was 12 months (range, 2–22) and the median time between transplants was 16 months (range, 5–30). The median follow-up of surviving patients after HCT2 was 33 months (range, 9–117), with 47% alive at time of analysis. The most common cause of death was disease recurrence (n = 6, 31%). At time of analysis, OS, PFS, relapse, and Transplant-Related Mortality (TRM) were 47% , 42%, 45%, and 21%, respectively. OS was 37% (3/8) for B-ALL. All T-cell ALL, CML-BC, MDS and JMML patients are alive, but all 5 patients with AML have died. None of the latter have used post-HCT maintenance to prevent relapse. Pre-HCT2 remission status did not appear to influence OS and PFS, since of 11 patients in remission, 5 remain alive and disease-free. Of the 8 patients transplanted with active disease, 6 remain in remission. Ten patients had HCT-CI < 2 pre HCT2, and 3 of 10 have died. However, 7 out of 9 patients with HCT-CI score ≥ 2 died (HR = 4.8, p = 0.007). Conclusion: A second HCT can be feasible for patients with relapsed malignant hematological diseases. Overall survival is higher than 40%, suggesting that this approach may cure a proportion of the patients, particularly those with HCT-CI < 2 pre HCT2. |
| first_indexed | 2024-03-11T17:06:36Z |
| format | Article |
| id | doaj.art-a4253c1a61cd4bc58f2d4f310857532d |
| institution | Directory Open Access Journal |
| issn | 2531-1379 |
| language | English |
| last_indexed | 2024-03-11T17:06:36Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hematology, Transfusion and Cell Therapy |
| spelling | doaj.art-a4253c1a61cd4bc58f2d4f310857532d2023-10-20T06:44:28ZengElsevierHematology, Transfusion and Cell Therapy2531-13792023-10-0145S533A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIESMF Cardoso0G Zamperlini1CNM Breviglieri2R Gouveia3VC Ginani4JF Marques5LL Quintino6LDS Domingues7MGAD Matos8A Seber9Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilGrupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilHospital Samaritano, São Paulo, SP, BrazilGrupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilGrupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilHospital Samaritano, São Paulo, SP, BrazilGrupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilGrupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilGrupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilGrupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, BrazilIntroduction: Relapse of a malignant hematological disease after allogeneic HCT is associated with poor survival and may not be treated with a curative intent. However, a second HCT (HCT2) may achieve durable remission. Objective: To determine the outcomes of pediatric patients who received a HCT2 for relapsed malignant hematological diseases. Casuistic and method: Review of the medical records of pediatric patients who underwent a HCT2 for relapsed malignant hematological diseases in two institutions from 2013 to 2023. OS was estimated using Kaplan-Meier survival analysis. The conventional HCT Comorbidity index (HCT-CI) was calculated for all patients (http://www.hctci.org/Home/Calculator) categorized in < or ≥ 2. Results: Nineteen patients with a median age of 10 years (range, 2–17) underwent HCT2 for B-ALL (n = 8), T-ALL (n = 2), AML (n = 5), CML-BC (n = 2), MDS (n = 1) and JMML (n = 1). Donor types were unrelated (n = 4), haploidentical (n = 11), and unrelated cord-blood (n = 4). Donors were different at HCT2 in all patients and all haploidentical HCT2 used the other haplotype. All nineteen patients received myeloablative conditioning, and 52% (n = 10) were in remission at HCT2. The median remission duration after HCT1 was 12 months (range, 2–22) and the median time between transplants was 16 months (range, 5–30). The median follow-up of surviving patients after HCT2 was 33 months (range, 9–117), with 47% alive at time of analysis. The most common cause of death was disease recurrence (n = 6, 31%). At time of analysis, OS, PFS, relapse, and Transplant-Related Mortality (TRM) were 47% , 42%, 45%, and 21%, respectively. OS was 37% (3/8) for B-ALL. All T-cell ALL, CML-BC, MDS and JMML patients are alive, but all 5 patients with AML have died. None of the latter have used post-HCT maintenance to prevent relapse. Pre-HCT2 remission status did not appear to influence OS and PFS, since of 11 patients in remission, 5 remain alive and disease-free. Of the 8 patients transplanted with active disease, 6 remain in remission. Ten patients had HCT-CI < 2 pre HCT2, and 3 of 10 have died. However, 7 out of 9 patients with HCT-CI score ≥ 2 died (HR = 4.8, p = 0.007). Conclusion: A second HCT can be feasible for patients with relapsed malignant hematological diseases. Overall survival is higher than 40%, suggesting that this approach may cure a proportion of the patients, particularly those with HCT-CI < 2 pre HCT2.http://www.sciencedirect.com/science/article/pii/S2531137923011574 |
| spellingShingle | MF Cardoso G Zamperlini CNM Breviglieri R Gouveia VC Ginani JF Marques LL Quintino LDS Domingues MGAD Matos A Seber A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIES Hematology, Transfusion and Cell Therapy |
| title | A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIES |
| title_full | A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIES |
| title_fullStr | A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIES |
| title_full_unstemmed | A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIES |
| title_short | A SECOND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT2) MAY CURE MORE THAN 40% PEDIATRIC PATIENTS WITH HEMATOLOGICAL MALIGNANCIES |
| title_sort | second allogeneic hematopoietic cell transplant hct2 may cure more than 40 pediatric patients with hematological malignancies |
| url | http://www.sciencedirect.com/science/article/pii/S2531137923011574 |
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