ALL is the most common cancer diagnosed in children and represents almost 25% of cancers in children younger than 15 years. Complete remission of disease is now typically achieved with pediatric chemotherapy regimens in approximately 95% of children with ALL, with up to 85% long-term survival rates. Those who relapse have few good options; retreatment rarely produces a cure.
Three randomized controlled trials (RCTs) that compared outcomes of hematopoietic SCT to outcomes with conventional-dose chemotherapy in children with ALL did not demonstrate superiority of transplantation in all comers but did suggest that those at high risk for relapse or those in relaspe adn remission, did better. The literature in general shows promising results for allogeneic SCT in patients in CR1 at high risk for recurrence, and in patients in second or greater remission. This conclusion is further supported by an evidence-based systematic review of the literature sponsored by the American Society for Blood and Marrow Transplantation (ASBMT)(Hahn et al). Outcomes following matched unrelated donor and umbilical cord blood transplants have improved significantly over the past decade and may offer outcome similar to that obtained with matched sibling donor transplants.
Hahn, T, Wall, D, Camitta, B, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute lymphoblastic leukemia in children: an evidence-based review. Biol Blood Marrow Transplant. 2005 Nov;11(11):823-61. Fagioli, F, Zecca, M, Rognoni, C, et al. Allogeneic Hematopoietic Stem Cell Transplantation for Philadelphia-Positive Acute Lymphoblastic Leukemia in Children and Adolescents: A Retrospective Multicenter Study of the Italian Association of Pediatric Hematology and Oncology (AIEOP). Biol Blood Marrow Transplant. 2011 Oct 20.
PDQ – http://www.cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional/page7
Gonzalez-Vicent, M, Molina, B, Andion, M, et al. Allogeneic hematopoietic transplantation using haploidentical donor vs. unrelated cord blood donor in pediatric patients: a single-center retrospective study. Eur J Haematol. 2011 Jul;87(1):46-53.
Nemecek, ER, Ellis, K, He, W, et al. Outcome of myeloablative conditioning and unrelated donor hematopoietic cell transplantation for childhood acute lymphoblastic leukemia in third remission. Biol Blood Marrow Transplant. 2011 Dec;17(12):1833-40. PM
Pui, CH, Pei, D, Campana, D, et al. Improved prognosis for older adolescents with acute lymphoblastic leukemia. J Clin Oncol. 2011 Feb 1;29(4):386-91. PMID: 21172890
Arico, M, Schrappe, M, Hunger, SP, et al. Clinical outcome of children with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia treated between 1995 and 2005. J Clin Oncol. 2010 Nov 1;28(31):4755-61.
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