TY - JOUR
T1 - Survival Differences between Adolescents/Young Adults and Children with B Precursor Acute Lymphoblastic Leukemia after Allogeneic Hematopoietic Cell Transplantation
AU - Burke, Michael J.
AU - Gossai, Nathan
AU - Wagner, John E.
AU - Smith, Angela R.
AU - Bachanova, Veronika
AU - Cao, Qing
AU - MacMillan, Margaret L.
AU - Stefanski, Heather S.
AU - Weisdorf, Daniel J.
AU - Verneris, Michael R.
N1 - Funding Information:
Financial disclosure: This work was supported by the National Cancer Institute (grant CA96028 , to M.B.), the Children’s Cancer Research Fund (M.B. and M.V.), the American Cancer Society (grant RSG-08-181 , to M.V.), and the University of Minnesota Pediatric Leukemia Program . The authors have no conflict of interest to disclose.
PY - 2013/1
Y1 - 2013/1
N2 - Risk-adapted therapy has been the cornerstone of treatment for pediatric B precursor acute lymphoblastic leukemia (B-ALL). Recently, age ≥13 years at diagnosis has been identified as a very high-risk feature for chemotherapy treated pediatric patients with B-ALL. Whether age at time of transplantation is associated with poor outcomes in adolescents and young adults (AYA) is unknown. We hypothesized that AYA receiving allogeneic hematopoietic cell transplantation (allo-HCT) would have greater relapse and inferior survival compared with children age <13 years. We reviewed the outcomes in 136 consecutive patients (age 0-30 years) with B-ALL who underwent myeloablative allo-HCT at our institution, including 79 children age <13 years (58%) and 57 AYA age 13-30 years (42%). Overall survival at 5 years was significantly lower in the AYA group (hazard ratio, 1.74; 95% confidence interval [CI], 1.04-2.95; P = .03). In addition, the AYA patients had a greater risk of transplantation-related mortality at 1 year (hazard ratio, 2.23; 95% CI, 1.01-4.90; P = .05), but no difference in relapse (relative risk, 0.85; 95% CI, 0.41-1.76; P = .66). Based on this analysis, AYA patients undergoing allo-HCT for B-ALL have significantly inferior survival and greater transplantation-related mortality compared with children age <13 years, but no difference in relapse, suggesting that allo-HCT may overcome relapse in AYA. Further improvements in peritransplantation care are needed to limit complications in AYA patients.
AB - Risk-adapted therapy has been the cornerstone of treatment for pediatric B precursor acute lymphoblastic leukemia (B-ALL). Recently, age ≥13 years at diagnosis has been identified as a very high-risk feature for chemotherapy treated pediatric patients with B-ALL. Whether age at time of transplantation is associated with poor outcomes in adolescents and young adults (AYA) is unknown. We hypothesized that AYA receiving allogeneic hematopoietic cell transplantation (allo-HCT) would have greater relapse and inferior survival compared with children age <13 years. We reviewed the outcomes in 136 consecutive patients (age 0-30 years) with B-ALL who underwent myeloablative allo-HCT at our institution, including 79 children age <13 years (58%) and 57 AYA age 13-30 years (42%). Overall survival at 5 years was significantly lower in the AYA group (hazard ratio, 1.74; 95% confidence interval [CI], 1.04-2.95; P = .03). In addition, the AYA patients had a greater risk of transplantation-related mortality at 1 year (hazard ratio, 2.23; 95% CI, 1.01-4.90; P = .05), but no difference in relapse (relative risk, 0.85; 95% CI, 0.41-1.76; P = .66). Based on this analysis, AYA patients undergoing allo-HCT for B-ALL have significantly inferior survival and greater transplantation-related mortality compared with children age <13 years, but no difference in relapse, suggesting that allo-HCT may overcome relapse in AYA. Further improvements in peritransplantation care are needed to limit complications in AYA patients.
KW - Myeloablative
KW - Relapse
KW - Transplant related mortality
UR - http://www.scopus.com/inward/record.url?scp=84871918387&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871918387&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2012.08.020
DO - 10.1016/j.bbmt.2012.08.020
M3 - Article
C2 - 22960388
AN - SCOPUS:84871918387
SN - 1083-8791
VL - 19
SP - 138
EP - 142
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 1
ER -