1. Treatment of relapse after allogeneic stem cell transplantation in children and adolescents with ALL: the Frankfurt experience
- Author
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Willasch, A M, Salzmann-Manrique, E, Krenn, T, Duerken, M, Faber, J, Opper, J, Kreyenberg, H, Bager, R, Huenecke, S, Cappel, C, Bremm, M, Pfirrmann, V, Merker, M, Ullrich, E, Bakhtiar, S, Rettinger, E, Jarisch, A, Soerensen, J, Klingebiel, T E, and Bader, P
- Abstract
Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach). If this was not feasible, low-dose chemotherapy and donor lymphocyte infusions (LDCHT+DLI) were offered (non-transplant approach). A total of 23 patients suffered a post-transplant relapse. Eight patients received HDCHT/SIT, followed by haploidentical SCT in 7/8. Ten received LDCHT+DLI. The eight patients treated with a second transplant and the ten treated with the non-transplant approach had a 4-year overall survival of 56% and 40%, respectively (P=0.232). Prerequisites for successful treatment of post-transplant relapse by either a second transplant or experimental non-transplant approaches are good clinical condition and the capacity to achieve haematological remission by the induction treatment element.
- Published
- 2017
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