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Pediatric High-Risk Leukemia Survival Has Improved Over Time

Improved AML/ALL outcomes following allogeneic, non-allogeneic hematopoietic cell transplantation

FRIDAY, July 22 (HealthDay News) -- Pediatric patients with high-risk leukemia, either acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), who are treated with contemporary protocols have improved survival compared to earlier cohorts and have a favorable outcome after hematopoietic cell transplantation (HCT), regardless of donor type, according to a study published in the July 14 issue of Blood.

Wing Leung, M.D., Ph.D., from St. Jude Children's Research Hospital in Memphis, Tenn., and colleagues examined whether children with high-risk leukemia, treated with contemporary protocols, had a higher risk of relapse or toxic death after HCT compared with earlier cohorts, and whether non-human leukocyte antigen-identical HCT yielded poor outcomes. In these protocols, 37 patients with ALL and 46 patients with AML underwent allogeneic HCT after receiving intensive multi-agent chemotherapy. The results were compared with those of 57 patients with ALL and 50 with AML from earlier cohorts.

The investigators found that the five-year overall survival rates for the recent cohorts were 65 and 74 percent for patients with ALL and AML, respectively. These survival rates compared favorably with those of earlier cohorts (28 percent and 34 percent, respectively). Regardless of donor type, the recent cohorts showed improvements (sibling, 70 percent versus 24 percent; unrelated, 61 percent versus 37 percent; and haploidentical, 88 percent versus 19 percent). Improved survival was significantly attributable to lower infection (hazard ratio [HR], 0.12), regimen-related toxicity (HR, 0.25), and leukemia-related death (HR, 0.40). Leukemia status (first remission versus more advanced disease; HR, 0.63) or minimal residual disease (positive versus negative; HR, 2.10) at the time of transplantation affected the probability of survival.

"Transplantation has improved over time and should be considered for all children with very-high-risk leukemia, regardless of matched donor availability," the authors write.

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