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

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,

DOI:

https://doi.org/10.21320/2500-2139-2013-6-1-53-59

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.

  • E.V. Semenova R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • N.V. Stancheva R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • S.N. Bondarenko R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • V.N. Vavilov R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • D.A. Bagge R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • O.V. Paina R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • S.V. Razumova R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • A.S. Borovkova R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • T.A. Bykova R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • A.A. Raths R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • L.S. Zuborovskaya R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
  • B.V. Afanasyev R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russian Federation ; Институт Детской Гематологии и Трансплантологии им. Р.М. Горбачевой, Санкт-Петербургский Государственный Медицинский Университет им. академика И. П. Павлова, Санкт-Петербург, Российская Федерация
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Keywords:

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

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Published

01.01.2013

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Vol. 6 No. 1 (2013)
LYMPHOID MALIGNANCIES

How to Cite

Semenova E.V., Stancheva N.V., Bondarenko S.N., et al. Management of refractory acute lymphoblastic leukemia in children and adolescents: remission re-induction followed by allogeneic hematopoietic stem cell transplantation. Clinical Oncohematology. Basic Research and Clinical Practice. 2013;6(1):53–59. doi:10.21320/2500-2139-2013-6-1-53-59.

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