Treatment of Czech children with acute lymphoblastic leukemia: A report of the Czech working group for pediatric hematology

2002 ◽  
Vol 39 (2) ◽  
pp. 125-127 ◽  
Author(s):  
Jan Starý ◽  
Petr Gajdoš ◽  
Hana Hrstková ◽  
Bohumír Blažek ◽  
Zdeněk Slavík ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Working Group ◽  
Lymphoblastic Leukemia ◽  
Pediatric Hematology

Treatment of childhood acute lymphoblastic leukemia in second remission with allogeneic bone marrow transplantation and chemotherapy: ten-year experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association.

1995 ◽  
Vol 13 (2) ◽  
pp. 352-358 ◽  
Author(s):  
C Uderzo ◽  
M G Valsecchi ◽  
A Bacigalupo ◽  
G Meloni ◽  
C Messina ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Lymphoblastic Leukemia ◽  
Allogeneic Bone Marrow Transplantation ◽  
Allogeneic Bone Marrow ◽  
Allogeneic Bone ◽  
Pediatric Hematology ◽  
First Relapse

PURPOSE To compare the results of allogeneic bone marrow transplantation (AlloBMT) with those obtained with chemotherapy (CHEMO) in children with acute lymphoblastic leukemia (ALL) in second complete remission (CR) after a marrow relapse. The experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association is summarized. PATIENTS AND METHODS All children who had a relapse in the period 1980 to 1989 in 27 centers in Italy were eligible for the study. Of 287 eligible patients, 230 were treated with CHEMO, most of them (93%) according to a standard multiple-drug relapse protocol. The remaining 57 children underwent AlloBMT. Preparative regimens included total-body irradiation and chemotherapy (n = 51) or chemotherapy alone (n = 6). Statistical analysis was performed with a Cox regression model adjusting for waiting time to transplant and prognostic factors. RESULTS In the whole series, minimum and median follow-up after second CR were 3 and 6.2 years, respectively; at 8 years from second CR, disease-free survival (DFS) was 20.0% (SE 2.5) and survival was 26.4% (SE 2.9). In the group of patients with an early first relapse, DFS was significantly longer after AlloBMT than after CHEMO (relative risk [RR] = 0.45, P = .002). No significant advantage of AlloBMT over CHEMO was found for patients with a late relapse (> 30 months since diagnosis). Duration of first CR significantly influenced prognosis in the CHEMO group (RR = 0.32, P = .0001 for patients with late first relapse versus patients with early first relapse). CONCLUSION Results suggest an advantage in DFS of AlloBMT over CHEMO in ALL patients who experienced an early first medullary relapse. Prospective trials are needed to address efficacy of AlloBMT versus CHEMO in patients with late bone marrow relapse.

Investigation of Epidemiologic Factors in Children with Acute Lymphoblastic Leukemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3948-3948
Author(s):  
Oznur Yilmaz ◽  
Cetin Timur ◽  
Asim Yoruk ◽  
Muferet Erguven ◽  
Elif Aktekin ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Ventilatory Support ◽  
Control Group ◽  
Healthy Children ◽  
High Concentration ◽  
Pediatric Hematology ◽  
Epidemiologic Factors ◽  
Significant Difference ◽  
The Mean

Abstract In this study, we aimed to investigate epidemiologic factors in children with Acute Lymphoblastic leukemia (ALL). The parents of 105 children diagnosed and treated as ALL between the years 1997 –2007 in our Clinic of Pediatric Hematology-Oncology were questioned and results were compared with control group that consisted of 102 healthy children with similar age and gender. The mean age of the patients was 8.57 ± 3.95 years. The mean age at diagnosis was 5.87 ± 3.73 years. There was no significant difference between the groups in terms of type of delivery, birth weight, asphyxia at birth, resuscitation with high-concentration oxygen and ventilatory support (p>0.05). There was also no significant difference between the groups in terms of duration of breast feeding. The rate of exposure to infections prior to diagnosis was higher in control group (p:0.003). Besides that, the rate of going to nursery was also significantly higher in control group (p:0.014). There was no difference between the groups in terms of X-ray exposure (p>0.05). In conclusion over-protection from infectious agents in and delay in meeting with some specific agents seems to increase ALL risk. Infections in early infantile period can be protective against leukemia. There has to be more extended studies on this subject.

Hematopoietic Cell Transplantation for Children with High Risk Acute Lymphoblastic Leukemia in First Complete Remission: A Report From the Italian Association of Pediatric Hematology and Oncology (AIEOP) Registry.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3036-3036
Author(s):  
Franca Fagioli ◽  
Paola Quarello ◽  
Marco Zecca ◽  
Edoardo Lanino ◽  
Carla Rognoni ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Lymphoblastic Leukemia ◽  
Pediatric Hematology ◽  
Donor Type ◽  
Grade Ii ◽  
Univariate Analyses ◽  
First Complete Remission ◽  
Grade Iii

Abstract Abstract 3036 Children with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) and high risk (HR) characteristics can benefit from allogeneic hematopoietic stem cell transplantation (HSCT). We carried out a retrospective, multicenter study to analyze the outcome of 211 consecutive ALL pediatric patients who received either related or unrelated (UD) HSCT for ALL in CR1 and were reported to the Italian Association of Pediatric Hematology and Oncology (AIEOP)-HSCT Registry between 1990 and 2008. Sixty-nine patients (33%) were transplanted between 1990 and 1999, 58 (27%) between 2000 and 2005, and 84 (40%) between 2005 and 2008. A matched family donor (MFD) was employed in 138 patients (65%) and an UD in 73 (35%). The 10-year probability of overall survival and disease-free survival (DFS) was 63.4% (95% CI, 57–70) and 61% (95% CI, 54–68), respectively. In univariate analyses, the donor type had an impact on DFS only for patients transplanted between 1990 and 1999 (MFD: 65% [95% CI, 53–77], UD: 33% [95% CI, 3–64], p=0.06). There were no differences between MFD and UD for patients who underwent HSCT after 2000. DFS was better in patients with grade 0-II aGvHD than in those with grade III-IV aGvHD (65% [95% CI, 58–62] and 40% [95% CI, 22–58], p=0.002). In multivariate analyses, the occurrence of grade IV aGvHD (RR=3.8 [95% CI, 1.58–9.20], p=0.002) was an independent factor associated with worse DFS. On the contrary, the occurrence of grade I and II aGvHD (RR=0.54 [95% CI, 0.29–0.99], p=0.05; RR=0.56 [95% CI 0.30–0.98], p=0.07) were independent favorable prognostic variables for DFS. The 10-year cumulative incidence of relapse incidence (RI) was 24% (95% CI, 19–30). In univariate analyses patients who experienced grade 0-I aGvHD (30% [95% CI, 23–40]) had higher RI than patients with grade II-IV aGvHD (15% [95% CI, 9–25) (p=0.013). In multivariate analysis, the occurrence of aGvHD remained an independent prognostic variable for RI. The 10-year cumulative incidence of transplant-related mortality (TRM) was 15% (95% CI, 11–21). In univariate analyses, TRM was lower for children aged 1–9 years at diagnosis as compared with those aged 10–14 years or older than 15 years (8% [95% CI, 4–15], 18% [95% CI, 11–31], and 54% [95% IC, 34–84], respectively, p<0.00001). The impact of donor type on TRM was only observed for patients transplanted between 1990 and 1999 (UD: 44%, [95% IC, 21–92], MFD: 8% [95% IC, 4–19], p=0.0043). Patients with grade III and IV aGvHD had TRM of 32% (95% CI, 16–61) and 82% (95% CI, 62–100), respectively, versus 13% (95% CI, 7–25), 3% (95% CI, 1–14) and 12% (95% CI, 6–26) of patients with grade II, I and 0 aGvHD, respectively (p<0.00001). In multivariate analysis the strongest predictors of TRM were grade IV aGvHD (RR 18.1 [95% IC, 4.37–75.3], p<0.00001) and UD donor for HSCT performed between 1990 and 1999 (RR 4.83 [95% IC, 1.43–16.3], p=0.01).In this study, 27 and 73 out of the 100 patients investigated had minimal residual disease (MRD)-intermediate risk (IR) and MRD-high risk (HR) features, respectively. The 27 with MRD-IR were given the allograft for the presence of other characteristics rendering them classifiable as HR. The probability of DFS and RI of MRD-IR and MRD-HR was comparable. Thus, although the number of patients investigated was limited, our results seem to suggest that HSCT could reduce or, at best, abrogate the effects of MRD on patient outcome. Our results suggest that after 1999 transplant outcomes are remarkably similar in recipients of UD and MFD. No advantage of total body irradiation (TBI) over chemotherapy in the conditioning regimen in terms of DFS, RI and TRM was found. The benefit offered by the occurrence of GvHD in terms of reduction of disease recurrence was, however, offset by a higher incidence of TRM. Indeed, taking patients who did not have aGvHD as the reference group, a better probability of DFS was observed only in patients who developed grade I-II aGvHD, this suggesting that only GvHD of mild/moderate severity can favorably impact on disease outcome. In conclusion, our data support the choice of performing allogeneic HSCT in pediatric and adolescent patients with HR ALL in CR1 from either MFD or UD. Randomized prospective cooperative group studies are desirable to establish the role of TBI-based conditioning in these patients. Disclosures: No relevant conflicts of interest to declare.

Pathways Through Relapses and Deaths of Children With Acute Lymphoblastic Leukemia: Role of Allogeneic Stem-Cell Transplantation in Nordic Data

2006 ◽  
Vol 24 (36) ◽  
pp. 5750-5762 ◽  
Author(s):  
Ulla M. Saarinen-Pihkala ◽  
Carsten Heilmann ◽  
Jacek Winiarski ◽  
Anders Glomstein ◽  
Jonas Abrahamsson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Lymphoblastic Leukemia ◽  
Population Based ◽  
Pediatric Hematology ◽  
Resistant Disease ◽  
First Relapse

Purpose Our focus was on patients with pediatric acute lymphoblastic leukemia (ALL) who experienced relapse or died without becoming transplantation candidates. The purpose was to outline measures needed to improve the outcome. Patients and Methods We analyzed our population-based 20-year data on 3,385 Nordic children with ALL treated on Nordic Society for Pediatric Hematology and Oncology ALL protocols, and described the flow of these patients through relapses, remissions, and deaths as a result of toxicity, demonstrating where major patient losses occurred. Results In total, 854 patients (25%) had a first and 274 patients (8%) had a second ALL relapse. P for survival after the first relapse was .35 ± .02. The induction mortality (2.2%, primary; 10.3%, first relapse; 26.3%, second relapse) and remission mortality (1%, first complete remission [1CR]; 19%, second CR [2CR]) were significant; transplantation-related mortality (TRM) only represented 15% (69 of 459) of the deaths as a result of toxicity. Of the 766 patients entering 2CR, 29% underwent transplantation (P for survival, .46 ± .04), whereas 71% continued receiving chemotherapy (P for survival, .39 ± .02). Children with stem-cell transplantation indications in 2CR, if they did not undergo transplantation, generally died or had a second relapse. The patient groups that underwent transplantation in 1CR (n = 84), 2CR (n = 220), and ≥ 3CR (n = 62) represented different risk profiles. Those with allogeneic stem-cell transplantation (allo-SCT) in ≥ 3CR (P for survival, .37 ± .07) had an ALL and first relapse with favorable features. Conclusion Major patient losses occurred through mortality as a result of toxicity and resistant disease during the pathways before allo-SCT. After relapse, more patients were lost to mortality as a result of toxicity during conventional chemotherapy compared with TRM. After second relapse, the chance for rescue by allo-SCT in ≥ 3CR was minimal. The question of whether transplantation is recommended after ALL relapse should be carefully addressed, and more efficient relapse protocols should be launched.

scholarly journals Bacteremia in Children with Acute Lymphoblastic Leukemia: A Five-year Experience in Pediatric Hematology- Oncology Unit in Northern Greece

2008 ◽  
Vol 12 ◽  
pp. S30
Author(s):  
Papageorgiou Theodotis ◽  
Pana Zoi Dorothea ◽  
Tragiannidis Athanasios ◽  
Theodoridou Agelliki ◽  
Tsotoulidou Biki ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Northern Greece ◽  
Pediatric Hematology ◽  
Oncology Unit
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