Excellent Outcomes of Hematopoietic Stem Cell Transplant for Pediatric High Risk and Relapsed Acute Myeloid Leukemia–A Decade Long Experience From Developing Nation
Bibliographic record
Abstract
AIM: Hematopoietic stem cell transplant (HSCT) remains the cornerstone of treatment in patients with high-risk and relapsed acute myeloid leukemia (AML). In the absence of a fully matched donor, haploidentical HSCT is a feasible option. The aim of this study is to analyze the outcomes of pediatric AML patients, who underwent HSCT at our center. METHODS: This was a retrospective analysis of 48 pediatric patients who underwent 50 transplants at our center from January 2014 to December 2024. RESULTS: Median age at transplant was 8.5 years, and the male-to-female ratio was 1.9:1. Of 48 children, 46 patients had de novo AML, and 2 had secondary AML. Twenty-nine patients underwent matched sibling donor (MSD), 3 underwent matched related donor (MRD) and the remaining 18 received haploidentical HSCT. All patients received Fludarabine-based conditioning regimens and engrafted. Incidence of acute graft versus host disease (GVHD) in matched donor and haploidentical HSCT was 21.8% and 44.4%, respectively ( P =0.09). Incidence of chronic GVHD was 3.1% in matched donor and 5.5% in haploidentical HSCT ( P =0.72). Cumulative incidence of relapse was 16%. Viral reactivations were seen in 17 patients, cytomegalovirus (CMV) being the commonest. At a median follow-up of 40.9 months, EFS and OS of the overall cohort were 78% and 86%, respectively. Nonrelapse mortality (NRM) was 6%. EFS in matched donor and haploidentical HSCT was 78.1% versus 77.8% ( P =0.78). OS in matched donor and haploidentical HSCT was 84.4% versus 88.9% ( P =0.83). GVHD-free relapse-free survival (GRFS) was 58%. Among the factors analyzed, only pretransplant minimal residual disease (MRD) positivity was found to be associated with significantly poor outcome. CONCLUSION: HSCT for children with AML from the developing world shows promising outcomes with high survival rates even in the absence of matched donors. Having expertise in multiple specialties, such as a molecular hematologist, infectious disease (ID), and intensive care specialist, can significantly enhance the outcomes for transplant patients.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 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".