Long-term outcomes for children who receive stem cell transplants for acute leukemia

This study aimed to identify ways to predict long-term outcomes of stem cell transplants for children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

This study concluded that factors such as age, age and disease status at time of transplant and presence of chronic GVHD influenced the risk score for acute leukemia and the long-term outcomes of the transplant. 

Allogeneic hematopoietic stem cell transplants (HSCT) are often used as treatment for ALL and AML patients. Allogeneic HSCT involves taking stem cells from a donor and giving them to a patient. 

Death in children with ALL or AML usually occurs within the first year after transplant. Following that first year, patients and parents generally wonder about long-term outcomes and survival. Methods of prediciting long-term outcomes following transplant are important. 

This study involved children under age 18 who had received a stem cell transplant and survived at least 1 year in remission. 790 patients with AML and 1096 with ALL were included.  Leukemia-free survival (LFS) and overall survival (OS) were measured and factors that may have influenced these were analyzed to develop a risk score.

There were no risk factors identified that predicted outcomes for either AML or ALL after 4 years of survival following the transplant. 

For AML, being more than 10 years of age at transplant or having chronic chronic graft versus host disease (GVHD, a condition in which the transplanted stem cells attack healthy tissue) was associated with decreased LFS and OS. Transplant during disease relapse and genetic factors were also associated with LFS and OS.

For ALL, factors such as age at transplantation and chronic GVHD were associated with LFS and OS.

For AML, the 10-year probability of OS with a good risk score (few risk factors) was 94%. This was 68% for patients with poor risk scores.

For ALL, the 10-year probability of OS with good a good risk score was 89%. It was 80% for those with a poor risk score. 

This study concluded that factors such as age, age and disease status at time of transplant and presence of chronic GVHD influenced the risk score for acute leukemia and the long-term outcomes of the transplant. 

Results have been generalized and further studies are needed. 

Discuss with your physician the any concerns you have about long-term outcomes of ALL/AML.