Outcome of Stem Cell Transplantation for Pediatric Acute Lymphoblastic Leukemia: Comparison of Matched Related Donor Verses Matched Unrelated Donor. Important Role of Graft Versus Host Disease in Preventing Relapse.
Notice bibliographique
Résumé
Abstract Seventy percent of children with acute lymphoblastic leukemia (ALL) who benefit from stem cell transplantation (SCT) lack a human leukocyte antigen (HLA) matched related donor (MRD). For these children SCT from a matched unrelated donor (MUD) represents an alternative therapeutic option. Our objective was, to review the outcome of children (0–18years) with ALL whom received a fully matched marrow allografts at our institution between July 1998 - December 2003. All children were conditioned with cyclophosphamide (50mg/kg infused over 1 hour daily for 4 days) followed by fractionated total body irradiation (TBI; 1200cGy, 6 fractions over 3 days). Cyclosporine A and a short course of methotrexate were used for graft versus host disease (GVHD) prophylaxis. Results: We performed 23 fully MRD and 23 fully MUD SCT during the study period. Median age at time of SCT was 10.2 y (range 2.2–17.5) and 8.2 y (range 1–16.5) for the MRD and MUD groups, respectively. Remission status at time of SCT; For the MRD group, complete remission (CR) 1, 2 and 3 were 5, 15 and 3 patients, respectively. For the MUD group, CR 1, 2 and 3 were 6, 14 and 3 patients, respectively. All patients engrafted for neutrophils (defined as absolute neutrophil count (ANC) of > 0.5 x 109/l for 2 consecutive days) with a median time of 18 days (range 12–28) and 16 days (range 10–25) for the MRD and MUD groups, respectively. In both groups, low grade acute(a) GVHD (I-II) occurred in 50% of the cases. However, high grade aGVHD (III-IV) occurred in 7/23 patients in the MUD group compared to only 1 patient with grade III aGVHD in the MRD group. Three years event free survival (EFS) for the whole group was 47 ± 8% with overall survival (OS), 50 ± 8%. EFS (3y) according to remission status was; 64 ± 15% for CR1, 51 ± 10% for CR2 and 33 ± 19% for CR3, P = 0.06. Twelve out of thirteen deaths in the MRD group were caused by leukemia relapse versus 3 out of 8 deaths in the MUD group. Transplant related mortality (TRM) was 5/8 deaths in the MUD group versus 1/13 deaths in the MRD group. Three years EFS and overall survival (OS) were, 37 ± 11%, 39 ± 11% for the MRD group and 63 ± 10%, 64 ± 10% (P = 0.16) for the MUD group. For the whole group, EFS according to aGVHD was, 29 ± 15% for no aGVHD, 51 ± 11% for low grade aGVHD and 60 ± 15% for high grade. Conclusion: Acute graft versus host disease is associated with less relapse post SCT for pediatric ALL, presumably through a graft-versus-leukemia effect. Our data suggests that outcomes can be improved further through exploring means of inducing aGVHD while reducing the toxicity of SCT. In MRD SCT where the likelihood of aGVHD is less and therefore relapse rate is higher, and in order to maximize survival in the non aGVHD group, attempts for aGVHD induction by early manipulation of the immunosuppressive medications or a low dose pre-emptive donor lymphocyte infusion in the first 60 days post engraftment, need to be explored in future studies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».