ALL is the most common cancer diagnosed in children and young adults 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. Young adults are treated as children, but the relapse rate is higher.
Relapsed patients can re-transplanted, receive DLI or go into clinical trials. O’Brien looked at 288 patients who received second salvage therapy for ALL and found that they have poor prognosis. It is tempting to retransplant patients who relapse despite an allogeneic transplant. A second BMT results in long-term event-free survival in only 10–20% of patients with relapsed ALL. Only 7–20% of patients has been reported to reach the stage of a second BMT after relapse according to the performance and remission status after salvage chemotherapy. Moreover, second BMT is associated with extremely high treatment-related mortality, ranging from 40% to 50%.
Thus, the outlook for patients with post-transplant relapse of acute leukemia is extremely poor; currently, no single therapy consistently results in durable remissions. There are no guidelines recommending a second allogeneic transplant and it is hard to see why a stem cell transplant would work better a second time unless something different is done.
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NCCN, ALL, ALL-7 2012