Management of refractory acute lymphoblastic leukemia in children and adolescents: remission re-induction followed by allogeneic hematopoietic stem cell transplantation

DIAGNOSIS AND TREATMENT OF LYMPHOID TUMORS , , , ,

E.V. Semenova, N.V. Stancheva, S.N. Bondarenko, V.N. Vavilov, D.A. Bagge, O.V. Paina, S.V. Razumova, A.S. Borovkova, T.A. Bykova, A.A. Raths, L.S. Zuborovskaya, B.V. Afanasyev

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation

ABSTRACT

Objective: to analyze efficacy of fludarabine- and nelarabine-containing chemotherapy  before  allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children and adolescents with relapsed and refractory acute lymphoblastic leukemia (ALL) .

Patients and methods: Thirty three patients (pts) with relapsed and refractory ALL from 1 till 21 y.o. (median age was 11,5 y.o.) were treated by fludarabine- (n=23) and nelarabine- (n=10) containing therapy.  Subsequently 24 patients underwent allo-HSCT.  

Results: CR was achieved in 11(48%) of 23 pts after FLAG±IDA and 7 (70%) of 10 pts after nelarabine-containg regimens. Duration of remissions were 1-18 months (median was 4,9 months).

Overall 3-year survival (OS) after allo-HSCT in remission was 58%, OS  after allo-HSCT in relapse was 8%, OS without allo-HSCT was 0%.

Conclusion: Fludarabine- and nelarabine-containing therapy can be used as bridge to allo-HSCT in children and adolescents with poor-prognosis ALL.

Кeywords: fludarabine, nelarabine, allo-HSCT, relapsed or refractory acute lymphoblastic leukemia, children and adolescents

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