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Medline ® Abstract for Reference 124

of 'Overview of the treatment of acute lymphoblastic leukemia in children and adolescents'

Early use of allogeneic hematopoietic stem cell transplantation for infants with MLL gene-rearrangement-positive acute lymphoblastic leukemia.
Koh K, Tomizawa D, Moriya Saito A, Watanabe T, Miyamura T, Hirayama M, Takahashi Y, Ogawa A, Kato K, Sugita K, Sato T, Deguchi T, Hayashi Y, Takita J, Takeshita Y, Tsurusawa M, Horibe K, Mizutani S, Ishii E
Leukemia. 2015;29(2):290. Epub 2014 Jun 3.
Sixty-two infants with MLL gene-rearrangement-positive acute lymphoblastic leukemia (MLL-r ALL) were treated with the MLL03 protocol of the Japanese Pediatric Leukemia/Lymphoma Study Group: short-course intensive chemotherapy followed by early allogeneic hematopoietic stem cell transplantation (HSCT) within 4 months of the initial induction. The 4-year event-free survival and overall survival rates were 43.2% (95% confidence interval (CI)=30.7-55.1%) and 67.2% (53.8-77.4%), respectively. A univariate analysis showed younger age (<90 days at diagnosis), central nervous system disease and poor response to initial prednisolone therapy significantly associated with poor prognosis (P<0.05). In a multivariate analysis, younger age at diagnosis tended to be associated with poor outcome (hazard ratio=1.969; 95% CI=0.903-4.291; P=0.088). Although the strategy of early use of HSCT effectively prevented early relapse and was feasible for infants with MLL-r ALL, the fact that substantial number of patients still relapsed even though transplanted in their first remission indicates the limited efficacy of allogeneic HSCT for infants with MLL-r ALL. Considering the risk of severe late effects, indications for HSCT should be restricted to specific subgroups with poor risk factors. An alternative approach incorporating molecular-targeted drugs should be established.
Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.