Improving outcomes of hematopoietic stem cell transplant for leukemia in children and young adults in resource-limited setting

Introduction: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative approach in patients with relapsed and high-risk leukemia. This retrospective analysis aimed to investigate outcomes and risk factors associated with HSCT in children and young adults with hematological malignancie...

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Main Authors: Garima Nirmal (Author), Subhashish Paul (Author), Vaibhav Chadha (Author), Shreyasi Das (Author), Mohit Chaudhary (Author), Manju Joseph (Author), Bharti Sharma (Author), Himshikha Yadav (Author), K.K. Swathymon (Author), Iskandarov Kamol (Author), Gaurav Kharya (Author)
Format: Book
Published: Elsevier, 2024-06-01T00:00:00Z.
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100 1 0 |a Garima Nirmal  |e author 
700 1 0 |a Subhashish Paul  |e author 
700 1 0 |a Vaibhav Chadha  |e author 
700 1 0 |a Shreyasi Das  |e author 
700 1 0 |a Mohit Chaudhary  |e author 
700 1 0 |a Manju Joseph  |e author 
700 1 0 |a Bharti Sharma  |e author 
700 1 0 |a Himshikha Yadav  |e author 
700 1 0 |a K.K. Swathymon  |e author 
700 1 0 |a Iskandarov Kamol  |e author 
700 1 0 |a Gaurav Kharya  |e author 
245 0 0 |a Improving outcomes of hematopoietic stem cell transplant for leukemia in children and young adults in resource-limited setting 
260 |b Elsevier,   |c 2024-06-01T00:00:00Z. 
500 |a 2468-1245 
500 |a 10.1016/j.phoj.2024.02.006 
520 |a Introduction: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative approach in patients with relapsed and high-risk leukemia. This retrospective analysis aimed to investigate outcomes and risk factors associated with HSCT in children and young adults with hematological malignancies in a resource-limited setting. Methods: We retrospectively evaluated 48 pediatric and young adult patients diagnosed with hematological malignancies who underwent HSCT at our institution between April 2017 and Jan 2023. Result: The median age of the cohort was 10 years (6 months - 21 years), and the majority of patients underwent transplants for acute lymphoblastic leukemia (ALL) (n = 24; 50 %) and acute myeloid leukemia (n = 18; 37.5%). Median time to neutrophil and platelet engraftment were 15 days (range 9-28) and 18 days (range 9-40), respectively. One patient had primary graft failure. Cytomegalovirus reactivation occurred in 21 patients (43.8%). Seventeen patients received escalated donor lymphocyte infusion (DLI). With a median follow-up of 902 days (52-2490), the probability of event free survival and overall survival (OS) was 65.9% and 69.4%. OS for lymphoid and myeloid malignancies were 64.7% and 75.2%, respectively. Kaplan-Meier probabilities of OS for patients in first complete remission (CR), CR2, CR3, or with refractory disease were 80%, 76.2%, 0%, and 40%, respectively (p = 0.02). OS of the patients undergoing matched sibling donor (n = 17) or haploidentical HSCT (n = 31) was 70.6% and 69%, respectively (p = 0.989). Conclusions: Our study demonstrates excellent outcomes of patients with hematological malignancies undergoing allogeneic HSCT with similar outcomes in HLA-identical sibling donors and haploidentical first-degree family donors. Prophylactic DLI might be considered in patients with high-risk leukemia to prevent relapse, including ALL. 
546 |a EN 
690 |a Hematological malignancies 
690 |a Children 
690 |a Young adults 
690 |a ALL 
690 |a AML 
690 |a MRD 
690 |a Pediatrics 
690 |a RJ1-570 
655 7 |a article  |2 local 
786 0 |n Pediatric Hematology Oncology Journal, Vol 9, Iss 2, Pp 105-113 (2024) 
787 0 |n http://www.sciencedirect.com/science/article/pii/S2468124524000111 
787 0 |n https://doaj.org/toc/2468-1245 
856 4 1 |u https://doaj.org/article/f7f095c6730e481b96325090e965db8c  |z Connect to this object online.