Allogeneic hematopoietic stem cel l transplantation in children’s acute myeloblastic leukemia:Survivaland relapse

Authors

  • Nour Ben Abdeljelil Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia https://orcid.org/0000-0001-9529-4192
  • Insaf Ben Yaiche Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Riheb Ouerghi Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Ines Turki Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Lamia Torjemane Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Dorra Belloumi Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Sabrine Mekni Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Rimel Kanoun Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Anna Chabaane Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Saloua Ladeb Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
  • Tarek Ben Othman Hematology and Transplantation Service, National Bone Marrow Transplant Center, 1006, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia

DOI:

https://doi.org/10.62438/tunismed.v103i11.5353

Keywords:

Allogeneic hematopoietic stem cell transplantation, acute myeloid leukemia, relapse, survival

Abstract

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is indicated for children with high-risk (HR) acute myeloid leukemia (AML).
Objective: To evaluate over all survival (OS), event-free survival (EFS), relapse, and non-relapse mortality (NRM).
Methods: This was a retrospective descriptive studyincludingchildren (<18 years) with AML whounderwent allo-HSCT from an HLA-identical sibling donorbetween 1999 and 2023. Conditioningregimensconsisted of busulfan–cyclophosphamide (BuCy) or total body irradiation–cyclophosphamide (TBI–Cy). Stem cell sources were bone marrow (BM) or peripheral blood stem cells.
Results:Fifty-two children were included, with a medianage of 13 years (range: 3–17). Patients were classified as HR in 60.3% of cases. The median time fromdiagnosis to transplantation was 5 months (range: 3–40). At transplantation, 75% of patients were in first completeremission (CR1). The stem cell source was BM in 84.6% of cases, and BuCy wasusedin 90.4% of patients. The graft rejection rate was 5.8%. The cumulative incidences of acute and chronicgraft-versus-host disease (GVHD) were 20% and 23.4%, respectively. The cumulative incidence of NRM was 7.7%, while relapse occurred in 44.7% of patients. After a median follow-up of 30 months (range: 39 days–18 years), the 3-year OS and EFS were 51.6% and 47.8%, respectively.
Conclusion: Post–allo-HSCT relapse remains a major challenge in pediatric AML. Intensification of pre-transplant conditioning, busulfanpharmacokinetic monitoring, and the development of targetedtherapiesmay help reduce the risk of relapse.

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