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AlloHSCT in paediatric ALL and AML in complete remission: improvement over time impacted by accreditation?

Bone Marrow Transplantation volume 54, pages 737–745 (2019)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplantation (alloHSCT) has become a well-established treatment option for many patients suffering from malignant and non-malignant diseases. In the past decade, high-resolution HLA-typing, remission surveillance, pre-emptive immune intervention, and standardisation in supportive care measures have substantially improved transplant outcomes. This retrospective study evaluated transplant procedures in 162 paediatric patients with acute lymphoblastic leukaemia (n = 124) or acute myeloid leukaemia (n = 38) who received their first alloHSCT in our institution over an 11-year period. We observed a significant reduction in risk of non-relapse mortality (NRM) over time (HR = 0.34, 95% CI 0.12–0.98; P = 0.05), the 4-year NRM estimate decreased from 20% in 2005–2008 to 7% in 2012–2016 (P = 0.02) and an increase in survival after relapse. There was no significant difference in patients who received a graft from a sibling, haplo, or an unrelated donor with regard to their overall survival (P = 0.45), event-free survival (P = 0.61), and non-relapse mortality (P = 0.19). Our data suggest that a specific transplant infrastructure with a highly experienced team in an accredited transplant centre likely contributes to better transplant outcomes for acute leukaemia patients in complete remission regardless of donor type.

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Acknowledgements

We thank our patients and their families.

Author contributions

SB, ESM, and PB designed the study. SB and PB wrote the manuscript. ESM and MH performed statistical analysis. TK, MD, JF, HR, MM, AB, SS, AMW, ER, JS, TEK, AJ, SB, and PB provided clinical data. HK, SH, CC, MB, and VP performed immune monitoring.

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Authors and Affiliations

  1. Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany

    Shahrzad Bakhtiar, Emilia Salzmann-Manrique, Martin Hutter, Hermann Kreyenberg, Sabine Huenecke, Claudia Cappel, Melanie Bremm, Verena Pfirrmann, Michael Merker, Anke Barnbrock, Stefan Schöning, Andre Manfred Willasch, Eva Rettinger, Jan Soerensen, Thomas Erich Klingebiel, Andrea Jarisch & Peter Bader

  2. Paediatric Haematology and Oncology, University of Saarland, Homburg/Saar, Germany

    Thomas Krenn

  3. Department of Paediatric Oncology, University of Mannheim, Mannheim, Germany

    Matthias Duerken

  4. Department of Paediatric Haematology and Oncology, Children’s Hospital of Johannes Gutenberg University, Mainz, Germany

    Joerg Faber

  5. Asklepios Kinderklinik Sankt Augustin Arnold-Janssen-Straße 29, 53757, St. Augustin, Germany

    Harald Reinhard

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  1. Shahrzad Bakhtiar
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  2. Emilia Salzmann-Manrique
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  19. Thomas Erich Klingebiel
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Corresponding author

Correspondence to Peter Bader.

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The authors declare that they have no conflict of interest. This work was funded by University Hospital Frankfurt.

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Bakhtiar, S., Salzmann-Manrique, E., Hutter, M. et al. AlloHSCT in paediatric ALL and AML in complete remission: improvement over time impacted by accreditation?. Bone Marrow Transplant 54, 737–745 (2019). https://doi.org/10.1038/s41409-018-0341-z

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