Different Kinetics and Risk Factors for Isolated Extramedullary Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Children with Acute Leukemia

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dc.authoridkaragun, barbaros sahin/0000-0002-7678-5524
dc.authoridOk Bozkaya, Ikbal/0000-0002-7666-8731
dc.authoridAksoy, Başak Adaklı/0000-0001-8338-2101
dc.authoriduygun, vedat/0000-0003-3257-7798
dc.authoridAtay, Didem/0000-0003-3040-1959
dc.authoridKarakukcu, Musa/0000-0003-2015-3541
dc.authoridKocak, Ulker/0000-0002-8701-5285
dc.authorscopusid6601954831
dc.authorscopusid7005581623
dc.authorscopusid57214444713
dc.authorscopusid10043117000
dc.authorscopusid6602113525
dc.authorscopusid8314098500
dc.authorscopusid54894552700
dc.authorwosidYalcin, Koray/AGD-9441-2022
dc.authorwosidkaragun, barbaros sahin/AAB-8587-2019
dc.authorwosidAksoy, Başak Adaklı/AAK-3627-2021
dc.authorwosidOk Bozkaya, Ikbal/P-4121-2015
dc.authorwosiduygun, vedat/AGH-4534-2022
dc.authorwosidaksoylar, serap/AAB-6343-2022
dc.authorwosidKaya, Zuhre/AAA-7871-2022
dc.contributor.authorHazar, Volkan
dc.contributor.authorOzturk, Gulyuz
dc.contributor.authorYalcin, Koray
dc.contributor.authorUygun, Vedat
dc.contributor.authorAksoylar, Serap
dc.contributor.authorKupesiz, A.
dc.contributor.authorBozkaya, Ikbal Ok
dc.date.accessioned2023-01-12T19:55:31Z
dc.date.available2023-01-12T19:55:31Z
dc.date.issued2021
dc.departmentN/A/Departmenten_US
dc.description.abstractRelapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most frequent cause of post-transplantation mortality. Isolated extramedullary (EM) relapse (iEMR) after HSCT is relatively rare and not well characterized, particularly in pediatric patients. We retrospectively analyzed 1527 consecutive pediatric patients with acute leukemia after allo-HSCT to study the incidence, risk factors, and outcome of iEMR compared with systemic relapse. The 5 -year cumulative incidence of systemic relapse (either bone marrow [BM] only or BM combined with EMR) was 24.8%, and that of iEMR was 5.5%. The onset of relapse after allo-HSCT was significantly longer in EM sites than in BM sites (7.19 and 5.58 months, respectively; P =.013). Complete response (CR) 2 +/active disease at transplantation (hazard ratio [HR], 3.1; P <.001) and prior EM disease (HR, 2.3; P =.007) were independent risk factors for iEMR. Chronic graft-versus-host disease reduced the risk of systemic relapse (HR, 0.5; P=.043) but did not protect against iEMR. The prognosis of patients who developed iEMR remained poor but was slightly better than that of patients who developed systemic relapse (3 -year overall survival, 16.5% versus 15.3%; P =.089). Patients experiencing their first systemic relapse continued to have further systemic relapse, but only a minority progressed to iEMR, whereas those experiencing their iEMR at first relapse developed further systemic relapse and iEMR at approximately similar frequencies. A second iEMR was more common after a first iEMR than after a first systemic relapse (58.8% versus 13.0%; P =.001) and was associated with poor outcome. iEMR has a poor prognosis, particularly after a second relapse, and effective strategies are needed to improve outcomes. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.en_US
dc.identifier.doi10.1016/j.jtct.2021.06.023
dc.identifier.issn2666-6375
dc.identifier.issn2666-6367
dc.identifier.issue10en_US
dc.identifier.pmid34216791en_US
dc.identifier.scopus2-s2.0-85111517361en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.1016/j.jtct.2021.06.023
dc.identifier.urihttps://hdl.handle.net/11454/76700
dc.identifier.volume27en_US
dc.identifier.wosWOS:000701826600014en_US
dc.identifier.wosqualityN/Aen_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherElsevier Science Incen_US
dc.relation.ispartofTransplantation and Cellular Therapyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAcute leukemiaen_US
dc.subjectPost-transplantation relapseen_US
dc.subjectChildrenen_US
dc.subjectBone-Marrow-Transplantationen_US
dc.subjectAcute Myelogenous Leukemiaen_US
dc.subjectMinimal Residual Diseaseen_US
dc.subjectTotal-Body Irradiationen_US
dc.subjectAcute Myeloid-Leukemiaen_US
dc.subjectPrognosisen_US
dc.subjectAmlen_US
dc.titleDifferent Kinetics and Risk Factors for Isolated Extramedullary Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Children with Acute Leukemiaen_US
dc.typeArticleen_US

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