Outcomes of Second Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Children.
Bibliographic record
Abstract
Abstract Introduction: Relapse of the malignancy, secondary malignancy and rejection of the graft (GF) remain important risk factors for mortality after HSCT. The optimal treatment strategy for GF is second HSCT, but for recurrent malignancy it has yet to be determined; however, second HSCT provides a chance for long term survival. This study reports outcomes and clinical experience of HSCT retransplantation in pediatric patients with GF, relapse or secondary malignancy after primary HSCT. Methods: Outcomes of all pediatric recipients of second HSCT for recurrent malignancy or GF between June 1, 1996 and June 30, 2006 at SickKids Hospital were reviewed. Demographic data, the conditioning regimen chosen, morbidity and mortality after second HSCT were described. EFS was defined as evidence of relapse of malignancy or failure to engraft. Univariate analysis was utilized to assess factors that may influence survival. Results: Forty-one children (25 male; median age 7.8yrs (range 0.6–17.5yrs)) received a second HSCT during the study period. Initial diagnosis was malignancy in 25 (AML/MDS-11, ALL-6, lymphoma-4, CML-3, JMML-1) and nonmalignant disease in 16 (SAA-4, SCID-4, inherited marrow failure symdrome-5, HLH- 1, MPS-1, thalasemia-1). Indications for second HSCT were: malignancy (recurrent/ secondary) in 21 and GF in 20. Mean time to second HSCT in children with GF was 10.5 months (range: 0.8–57.2 months) compared to 22.7 months (range: 10.1–58.1months) for malignancy (p=0.004). All patients transplanted for malignancy received the second HSCT ≥ 6 months from the first HSCT and only 5 (24%) were transplanted within a year from first HSCT. 8 patients (40%) receiving a second HSCT for GF were retransplanted within the first 6 months. Conditioning regimens at second HSCT included myeloablative treatment (23); reduced intensity (RIC) (16) and none (2). The following factors were not statistically associated with survival: underlying disease, type of conditioning regimen (myeloablative vs reduced intensity) and indication for second HSCT (GF vs. malignancy). Overall survival (OS) and EFS rates are summarized below. Non-relapse related mortality was 45%; 9 patients died from infections. parameters OS EFS Underlying disease Malignant 0.37±0.1 Non-Malignant 0.49±0.13 p=0.64 Reason for second HSCT Recurrent/secondary malignancy 0.43±0.11 Graft failure 0.42±0.12 p=0.69 Conditioning regimen Myeloablative 0.48±0.1 Reduce-intensity 0.33±0.13 p=0.3 All patients 0.425 0.44 Discussion and conclusion: Children who underwent second HSCT had an OS of 43%. We conclude that a second HSCT can result in prolonged EFS in children relapsing more than 6months after first HSCT and provides an acceptable therapeutic option for patients with GF.
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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 | 0.001 | 0.001 |
| 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".