Unrelated cord blood transplantation for central nervous system relapse in high-risk childhood acute lymphoblastic leuke
- PDF / 211,991 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 9 Downloads / 173 Views
ORIGINAL ARTICLE
Unrelated cord blood transplantation for central nervous system relapse in high-risk childhood acute lymphoblastic leukemia Changcheng Zheng & Baolin Tang & Juan Tong & Huilan Liu & Liangquan Geng & Xingbing Wang & Kaiyang Ding & Zimin Sun
Received: 7 February 2013 / Accepted: 10 June 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Few clinical studies have investigated the role of unrelated cord blood transplantation (CBT) for central nervous system (CNS) relapse of childhood acute lymphoblastic leukemia (ALL) patients with high-risk factors. The aim of this report is to identify the potential benefits of unrelated CBT in high-risk childhood ALL with CNS relapse who has been treated on CNSdirected treatment strategies. Eleven childhood ALL patients with CNS relapse who underwent unrelated CBT enrolled in our study between 2001 and 2011, and all of the patients had features associated with poor outcomes, such as high white blood cells at diagnosis, ph+chromosome, or a history of bone marrow relapse. All transplants were performed with myeloablativeconditioning therapy (BU/cyclophosphamide (CY2) or total body irradiation/CY) plus highly CNS-active agents (carmustine or high-dose cytarabine). All patients achieved neutrophil engraftment and platelet engraftment. A total of nine patients (81.8 %) developed pre-engraftment syndrome at a median of 7 days, and three patients developed acute graft-vs-host disease at a median of 21 days. The median follow-up after CBT was 28.5 months. The probability of overall survival at 9 years was 63.6 %, and no patient experienced a CNS relapse. Our experience suggests that unrelated CBT appears to be an effective treatment option for CNS relapse of childhood ALL patients associated with poor outcome features. Keywords Cord blood transplantation . Central nervous system relapse . Acute lymphoblastic leukemia C. Zheng : Z. Sun Shandong University School of Medicine, Jinan 2500012, China C. Zheng : B. Tang : J. Tong : H. Liu : L. Geng : X. Wang : K. Ding : Z. Sun (*) Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei 230001, China e-mail: [email protected]
Introduction Clinical trials have yielded 5-year event-free survival rates as high as 81–85.6 % among children with acute lymphoblastic leukemia (ALL) [1–3]. Depending on the efficacy of contemporary induction protocols and the routine use of central nervous system (CNS) prophylaxis without cranial irradiation, approximately 2.6–2.7 % of patients with ALL will develop isolated CNS relapse [1, 2]. The strategy of intensive systemic and intrathecal chemotherapy or combined with CNS irradiation has yielded long-term second eventfree survival rates of 70–80 % in children with isolated CNS relapse [4–6]. But CNS relapse in high-risk childhood patients with a short initial remission duration, bone marrow (BM) relapse, T cell ALL, or prior cranial irradiation continues to pose a therapeutic challenge and remains a major obstacle to cure [6, 7]. The role of allo
Data Loading...
