Allogeneic hematopoietic stem cell transplant in pediatric acute myeloid leukemia: Lessons learnt from a tertiary care center in India.
HEPA filter
allogeneic stem cell transplant
pediatric acute myeloid leukemia
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
revised:
09
09
2020
received:
15
05
2020
accepted:
18
10
2020
pubmed:
4
11
2020
medline:
21
1
2022
entrez:
3
11
2020
Statut:
ppublish
Résumé
There is paucity of data on outcomes of MSD-HSCT in children with relapsed or high-risk AML from developing countries, which have unique challenges including adverse host factors and resource constraints. We retrospectively reviewed records of children (age ≤ 18 years) who underwent MSD-HSCT for AML at our center from 2009 to 2019 to evaluate clinical outcome and its predictors using Cox proportional hazards model. There were 46 children (36 boys and 10 girls) with mean age 10.7 ± 4.8 years. Indication for HSCT was relapsed AML in CR2 (n = 37), primary refractory (n = 3), or relapsed refractory disease (n = 3); high-risk (n = 1) or secondary (n = 2) AML in CR1. Five-year EFS and OS were 33.3 ± 7.2% and 36.3 ± 7.6%, respectively. On multivariate analysis, CR1 duration less than 12 months, presence of active disease at transplant, and use of bone marrow stem cell graft were associated with poorer EFS and OS. There was one (2.2%) TRM, while disease relapse occurred in 20/40 patients who underwent HSCT in remission. Though the 5-year EFS and OS were inferior to results reported from high-income countries, relapse (and not TRM) was the major cause of treatment failure. A well-sustained CR1, achievement of disease remission, and use of peripheral blood allograft seem imperative to a successful transplant. Targeted therapy along with HSCT may be the option for those with early relapse.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13918Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Pui C-H, Carroll WL, Meshinchi S, Arceci RJ. Biology, risk stratification, and therapy of pediatric acute leukemias: an update. J Clin Oncol. 2010;29(5):551-565.
Sweeney C, Vyas P. The graft-versus-leukemia effect in AML. Front Oncol. 2019;9. https://doi.org/10.3389/fonc.2019.01217
Vokurka S, Bystrická E, Svoboda T, et al. The availability of HEPA-filtered rooms and the incidence of pneumonia in patients after haematopoietic stem cell transplantation (HSCT): results from a prospective, multicentre, eastern European study. J Clin Nurs. 2014;23(11-12):1648-1652.
Kumar R, Naithani R, Mishra P, et al. Allogeneic hematopoietic SCT performed in non-HEPA filter rooms: initial experience from a single center in India. Bone Marrow Transplant. 2009;43(2):115-119.
Ganapule A, Nemani S, Korula A, et al. Allogeneic stem cell transplant for acute myeloid leukemia: evolution of an effective strategy in India. J Glob Oncol. 2017;3(6):773-781.
Abdel-Rahman F, Hussein A, Rihani R, et al. Bone marrow and stem cell transplantation at King Hussein cancer center. Bone Marrow Transplant. 2008;42(Suppl 1):S89-S91.
Hussein AA, Hamidieh AA, Elhaddad A, et al. First report of pediatric hematopoietic stem cell transplantation activities in the eastern mediterranean region from 1984 to 2011: on behalf of the pediatric cancer working committee of the eastern mediterranean blood and marrow transplantation group. Bone Marrow Transplant. 2017;52(1):120-125.
Yeh AC, Khan MA, Harlow J, et al. Hematopoietic stem-cell transplantation in the resource-limited setting: establishing the first bone marrow transplantation unit in Bangladesh. J Glob Oncol. 2016;4:1-10.
Yadav SP, Sachdeva A. Pediatric allogeneic stem cell transplantation: experience from the developing world. Pediatr Hematol Oncol. 2014;31(3):205-206.
Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114(5):937-951.
Creutzig U, van den Heuvel-Eibrink MM, Gibson B, et al. Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel. Blood. 2012;120(16):3187-3205.
O'Hare P, Lucchini G, Cummins M, et al. Allogeneic stem cell transplantation for refractory acute myeloid leukemia in pediatric patients: the UK experience. Bone Marrow Transplant. 2017;52(6):825-831.
Bhethanabhotla S, Sahoo RK, Kumar L, Sharma A, Bakhshi S. Cyclophosphamide followed by Busulphan in place of standard BuCy regimen for patients undergoing allogeneic stem cell transplantation: a preliminary experience from a single centre in India. Blood. 2014;124(21):5856.
Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 diagnosis and staging working group report. Biol Blood Marrow Transplant. 2015;21(3):389-401.e1.
Rowlings PA, Przepiorka D, Klein JP, et al. IBMTR severity index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade. Br J Haematol. 1997;97(4):855-864.
Sander A, Zimmermann M, Dworzak M, et al. Consequent and intensified relapse therapy improved survival in pediatric AML: results of relapse treatment in 379 patients of three consecutive AML-BFM trials. Leukemia. 2010;24(8):1422-1428.
Abrahamsson J, Clausen N, Gustafsson G, et al. Improved outcome after relapse in children with acute myeloid leukaemia. Br J Haematol. 2007;136(2):229-236.
Beier R, Albert MH, Bader P, et al. Allo-SCT using BU, CY and melphalan for children with AML in second CR. Bone Marrow Transplant. 2013;48(5):651-656.
Aladjidi N, Auvrignon A, Leblanc T, et al. Outcome in children with relapsed acute myeloid leukemia after initial treatment with the French Leucemie Aique Myeloide Enfant (LAME) 89/91 protocol of the French Society of Pediatric Hematology and Immunology. J Clin Oncol Off J Am Soc Clin Oncol. 2003;21(23):4377-4385.
Carpenter PA, Meshinchi S, Davies SM. Transplantation for AML in children. Biol Blood Marrow Transplant. 2012;18(1):S33-S39.
Kulkarni KP, Marwaha RK. Childhood acute myeloid leukemia: an Indian perspective. Pediatr Hematol Oncol. 2011;28(4):257-268.
Kulkarni U, George B. Access to hematopoietic stem-cell transplantation in India. J Postgrad Med. 2019;65(1):1.
Ossenkoppele GJ, Janssen JJWM, van de Loosdrecht AA. Risk factors for relapse after allogeneic transplantation in acute myeloid leukemia. Haematologica. 2016;101(1):20-25.
Doherty EE, Redell M, Sasa G, et al. Outcomes after allogeneic hematopoietic stem cell transplantation for pediatric acute myeloid leukemia in the contemporary era. Blood. 2019;134(Suppl. 1):2056.
Christopher MJ, Petti AA, Rettig MP, et al. Immune escape of relapsed AML cells after allogeneic transplantation. N Engl J Med. 2018;379(24):2330-2341.
Shaw BE, Mufti GJ, Mackinnon S, et al. Outcome of second allogeneic transplants using reduced-intensity conditioning following relapse of haematological malignancy after an initial allogeneic transplant. Bone Marrow Transplant. 2008;42(12):783-789.
Bejanyan N, Weisdorf DJ, Logan BR, et al. Survival of patients with acute myeloid leukemia relapsing after allogeneic hematopoietic cell transplantation: a center for international blood and marrow transplant research study. Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant. 2015;21(3):454-459.
Thekkudan SF, de Lima M, Metheny L. Prevention of relapse after allogeneic stem cell transplantation in acute myeloid leukemia: updates and challenges. Adv Cell Gene Ther. 2020;3(2):e77.
Keating AK, Langenhorst J, Wagner JE, et al. The influence of stem cell source on transplant outcomes for pediatric patients with acute myeloid leukemia. Blood Adv. 2019;3(7):1118-1128.
Zheng F-M, Zhang X, Li C-F, et al. Haploidentical- versus identical-sibling transplant for high-risk pediatric AML: a multi-center study. Cancer Commun. 2020;40(2-3):93-104.
Bacigalupo A, Maiolino A, Van Lint MT, et al. Cyclosporin A and chronic graft versus host disease. Bone Marrow Transplant. 1990;6(5):341-344.
Lönnqvist B, Aschan J, Ljungman P, Ringdén O. Long-term cyclosporin therapy may decrease the risk of chronic graft-versus-host disease. Br J Haematol. 1990;74(4):547-548.
Yang J, Cai Y, Jiang J, et al. Early tapering of immunosuppressive agents after HLA-matched donor transplantation can improve the survival of patients with advanced acute myeloid leukemia. Ann Hematol. 2018;97(3):497-507.
Webb DKH, Wheatley K, Harrison G, Stevens RF, Hann IM. Outcome for children with relapsed acute myeloid leukaemia following initial therapy in the Medical Research Council (MRC) AML 10 trial. Leukemia. 1999;13(1):25-31.
Zhang J, Gu Y, Chen B. Mechanisms of drug resistance in acute myeloid leukemia. OncoTargetsTher. 2019;12:1937-1945.
Parkin B, Ouillette P, Li Y, et al. Clonal evolution and devolution after chemotherapy in adult acute myelogenous leukemia. Blood. 2013;121(2):369-377.
Skalska-Sadowska J, Wachowiak J, Zając-Spychała O, et al. Outcome of refractory and relapsed acute myeloid leukemia in children treated during 2005-2011 - experience of the Polish PediatricLeukemia/Lymphoma Study Group (PPLLSG). Contemp Oncol Poznan Pol. 2014;18(1):48-53.
Gorman MF, Ji L, Ko RH, et al. Outcome for children treated for relapsed or refractory acute myelogenous leukemia (rAML): a Therapeutic Advances in Childhood Leukemia (TACL) Consortium study. Pediatr Blood Cancer. 2010;55(3):421-429.
Quarello P, Fagioli F, Basso G, et al. Outcome of children with acute myeloid leukaemia (AML) experiencing primary induction failure in the AIEOP AML 2002/01 clinical trial. Br J Haematol. 2015;171(4):566-573.
Bunin NJ, Davies SM, Aplenc R, et al. Unrelated donor bone marrow transplantation for children with acute myeloid leukemia beyond first remission or refractory to chemotherapy. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26(26):4326-4332.
Shimosato Y, Tanoshima R, Tsujimoto S, et al. Allogeneic bone marrow transplantation versus peripheral blood stem cell transplantation for hematologic malignancies in children: a systematic review and meta-analysis. Biol Blood Marrow Transplant. 2020;26(1):88-93.
Buckley SA, Wood BL, Othus M, et al. Minimal residual disease prior to allogeneic hematopoietic cell transplantation in acute myeloid leukemia: a meta-analysis. Haematologica. 2017;102(5):865-873.
Norkin M, Katragadda L, Zou F, et al. Minimal residual disease by either flow cytometry or cytogenetics prior to an allogeneic hematopoietic stem cell transplant is associated with poor outcome in acute myeloid leukemia. Blood Cancer J. 2017;7(12):1-8.
Oran B, Jorgensen JL, Marin D, et al. Pre-transplantation minimal residual disease with cytogenetic and molecular diagnostic features improves risk stratification in acute myeloid leukemia. Haematologica. 2017;102(1):110-117.
Czyz A, Nagler A. The role of measurable residual disease (MRD) in hematopoietic stem cell transplantation for hematological malignancies focusing on acute leukemia. Int J Mol Sci. 2019;20(21):5362.
Schuurhuis GJ, Heuser M, Freeman S, et al. Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party. Blood. 2018;131(12):1275-1291.
Ullmann AJ, Schmidt-Hieber M, Bertz H, et al. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol. 2016;95(9):1435-1455.
Eckmanns T, Rüden H, Gastmeier P. The influence of high-efficiency particulate air filtration on mortality and fungal infection among highly immunosuppressed patients: a systematic review. J Infect Dis. 2006;193(10):1408-1418.
Palmer J, McCune JS, Perales M-A, et al. Personalizing Busulfan-based conditioning: considerations from the American Society for Blood and Marrow Transplantation Practice Guidelines Committee. Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant. 2016;22(11):1915-1925.
Andersson BS, Thall PF, Valdez BC, et al. Fludarabine with pharmacokinetically guided IV busulfan is superior to fixed-dose delivery in pretransplant conditioning of AML/MDS patients. Bone Marrow Transplant. 2017;52(4):580-587.
Tyagi A, Pramanik R, Chaudhary S, Chopra A, Bakhshi S. Cytogenetic profiles of 472 Indian children with acute myeloid leukemia. Indian Pediatr. 2018;15(6):469-473.
Reikvam H, Hatfield KJ, Kittang AO, Hovland R, Bruserud Ø. Acute myeloid leukemia with the t(8;21) translocation: clinical consequences and biological implications. J Biomed Biotechnol. 2011;2011:104631.
Pramanik R, Tyagi A, Chopra A, Kumar A, Vishnubhatla S, Bakhshi S. Myeloid sarcoma predicts superior outcome in pediatric AML; can cytogenetics solve the puzzle? Clin Lymphoma Myeloma Leuk. 2018;18(6):e249-e254.
Brunner AM, Werner L, Story JL, et al. Cytogenetic evolution between diagnosis and relapse and impact on acute myeloid leukemia (AML) reinduction outcomes. J Clin Oncol. 2017;35(15_suppl):e18509. https://doi.org/10.1200/JCO.2017.35.15_suppl.e18509
Ganguly S, Kinsey S, Bakhshi S. Childhood cancer in India. Cancer Epidemiol. 2020;101679. https://doi.org/10.1016/j.canep.2020.101679
Rubnitz JE, Inaba H, Dahl G, et al. Minimal residual disease-directed therapy for childhood acute myeloid leukemia: results of the AML02 multicenter trial. Lancet Oncol. 2010;11(6):543-552.