359: Outcome of matched sibling donor hematopoietic stem cell transplantation for standard risk pediatric acute myelogenous leukemia in first complete remission
Bibliographic record
Abstract
In recent years there has been a significant improvement in the outcome of children with standard risk acute myelogenous leukemia (AML) treated with chemotherapy only. In the MRC-UK trials 10 and 12, standard risk AML children were allowed to proceed to hematopoietic stem cell transplantation (HSCT) if there is a full matched family donor. However, with the excellent results of chemotherapy and the known risks and long term effects of HSCT, this decision remains controversial. Herein, our objective was to review the outcome of all children between 1995-2005 with standard risk AML who received a matched sibling donor (MSD) in CR1 in our institution and compare their outcome with the published MRC-UK results. Standard risk features were defined according to the MRC-UK criteria. Thirty-two consecutive children (16 males:16 females) received MSD HSCT between 1995-2005 at the Hospital for Sick Children, Toronto. Median age was 8.4 years (range 0.5-17.5 years). Conditioning regimens included; busulphan/cyclophosphamide (Bu/Cy) n=23; Cy/Total body irradiation (TBI) n=4, VP16/TBI n=4 and Bu/Melphalan (Bu/Mel) n=1. Graft-versus-host disease (GVHD) prophylaxis was with cyclosporine A and a short course of methotrexate. All patients engrafted apart from one patient who was conditioned with VP16/TBI and suffered a primary graft failure. That patient was re-conditioned with Bu/Cy/ATG and successfully engraft and still alive 6 years post the second HSCT. Acute grade I-II and grade III-IV GVHD occurred in 6 and 1 patients, respectively. Chronic GVHD affected 3 patients, limited in 2 and extensive in 1. One patient died from transplant related mortality (TRM). Eight patients relapsed and six died from their disease. Two relapsed patients received a second HSCT and continue to be in remission for 8 and 55 months, respectively. For a median follow up of 52 months (range 6-104 months), the relapse free survival (RFS) is 75% and the event free survival (EFS) including the 2 patients who received the second HSCT is 81%. Larger studies such as the MRC-UK 10 and 12 reported 63% RFS. Conclusion: Outcome of children with standard risk AML transplanted from a MSD in CR1 is very encouraging with minimal toxicity. HSCT for standard risk patient with an available family donor should be recommended.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".