Pre-transplant minimal residual disease in children with acute lymphoblastic leukemia

Improved outcome in childhood ALL with intensive consolidation and hematopoietic stem cell transplant

Background

Despite advances in chemotherapy, the prognosis of relapsed acute lymphoblastic leukemia (ALL) remains poor. Few studies on relapsed ALL have reported the importance of intensive consolidation followed with or without allogeneic hematopoietic stem cell transplantation (HSCT).

Methods

We evaluated the post-relapse outcomes in 47 Korean children with a first marrow relapse, and analyzed the prognostic factors.

Results

A second complete remission (CR) was achieved in 40 patients (85.1%), and at the time of this study, second CR was maintained in 12 of these patients. The estimated 3-yr event-free survival (EFS) rate after the first marrow relapse was 29.8±6.7%, and the overall survival (OS) rate was 45.3±7.5%. We found that second remission, consolidation of pediatric oncology group chemotherapy regimen (POG 9411), and HSCT significantly affected the outcome of the disease after relapse (P<0.001; P=0.004; P=0.05).

Conclusion

The results of our study revealed that an intensified POG 9411 consolidation chemotherapy regimen followed by HSCT can improve the outcome of patients with relapsed ALL.

The combination of clofarabine and cytarabine in pediatric relapsed acute lymphoblastic leukemia: a case report

BACKGROUND

Despite significant advances in treatment and survival rates in pediatric acute leukemias, relapse remains a common reason for treatment failure. Survival following relapse is dismal for most patients. Clofarabine, a purine nucleoside analog, has recently been approved for use in relapsed and refractory pediatric acute lymphoblastic leukemia. Clofarabine and cytarabine together may be synergistic and have been used safely in adult leukemia patients.

CASE REPORT

We describe the administration of this combination to a 9-year-old boy with multiple relapsed T-cell acute lymphoblastic leukemia who failed to achieve remission after the third attempt. He achieved complete morphologic and cytogenetic remission with 1 cycle of this combination.

CONCLUSION

This case is the first report of successful remission induction in a multiple relapsed pediatric leukemia patient using the clofarabine and cytarabine combination. Although it is a single case, it highlights the need for further studies to assess safety and efficacy of this combination in pediatric patients.