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Acute Leukemia

Treatment of relapse after allogeneic stem cell transplantation in children and adolescents with ALL: the Frankfurt experience

Bone Marrow Transplantation volume 52, pages 201–208 (2017)Cite this article

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Abstract

Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach). If this was not feasible, low-dose chemotherapy and donor lymphocyte infusions (LDCHT+DLI) were offered (non-transplant approach). A total of 23 patients suffered a post-transplant relapse. Eight patients received HDCHT/SIT, followed by haploidentical SCT in 7/8. Ten received LDCHT+DLI. The eight patients treated with a second transplant and the ten treated with the non-transplant approach had a 4-year overall survival of 56% and 40%, respectively (P=0.232). Prerequisites for successful treatment of post-transplant relapse by either a second transplant or experimental non-transplant approaches are good clinical condition and the capacity to achieve haematological remission by the induction treatment element.

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Acknowledgements

We thank the LOEWE Center for Cell and Gene Therapy Frankfurt, which is funded by the Hessian Ministry of Higher Education, Research and the Arts, funding reference number: III L 4-518/17.004 (2013).

Author contributions

Conception and design: PB and TEK. Referral and treatment of patients: PB, TEK, JS, AJ, AMW, ER, SB, TK, MD, JF and JO. Data analysis and interpretation: PB, AMW, HK, ES-M, RB, SH, CC, MB, VP, MM and EU. Manuscript writing: AMW, PB and ES-M. Final approval of the manuscript: all authors.

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Authors and Affiliations

  1. Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany

    A M Willasch, E Salzmann-Manrique, H Kreyenberg, R Bager, S Huenecke, C Cappel, M Bremm, V Pfirrmann, M Merker, E Ullrich, S Bakhtiar, E Rettinger, A Jarisch, J Soerensen, T E Klingebiel & P Bader

  2. Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany

    T Krenn

  3. Department of Pediatric Oncology, University of Mannheim, Mannheim, Germany

    M Duerken

  4. Department of Pediatric Hematology and Oncology, Children's Hospital of Johannes Gutenberg University, Mainz, Germany

    J Faber & J Opper

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  1. A M Willasch
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Correspondence to A M Willasch or P Bader.

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Willasch, A., Salzmann-Manrique, E., Krenn, T. et al. Treatment of relapse after allogeneic stem cell transplantation in children and adolescents with ALL: the Frankfurt experience. Bone Marrow Transplant 52, 201–208 (2017). https://doi.org/10.1038/bmt.2016.224

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