Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience
BackgroundHematopoietic cell transplantation (HCT) represents a well-established therapeutic strategy for high-risk leukemia, though post-transplant relapse remains a significant challenge, particularly in resource-limited settingsProcedureIn this retrospective study, we analyzed medical records of...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-03-01
|
| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1573334/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850059693322403840 |
|---|---|
| author | Polliany Roberta Dorini Pelegrina Polliany Roberta Dorini Pelegrina Rita de Cassia Barbosa Tavares Adriana Mello Rodrigues Adriana Mello Rodrigues Adriana Mello Rodrigues Gisele Loth Gisele Loth Gisele Loth Samantha Nichele Samantha Nichele Cilmara Kuwahara Fernanda Moreira de Lara Benini Carolina Martins de Almeida Peixoto Juliana Bach Juliana Bach Joanna Trennepohl Lara Maria Miranda de Gouvea Lara Maria Miranda de Gouvea Rafaella Muratori Adriana Koliski Rebeca Toassa Gomes Marcia Quiroga Marcia Quiroga Simone Pereira Lermontov Valeria Gonçalves da Silva Ana Paula de Azambuja Margareth Kleina Feitosa Margareth Kleina Feitosa Alberto Cardoso Martins Lima Carmem Bonfim Carmem Bonfim |
| author_facet | Polliany Roberta Dorini Pelegrina Polliany Roberta Dorini Pelegrina Rita de Cassia Barbosa Tavares Adriana Mello Rodrigues Adriana Mello Rodrigues Adriana Mello Rodrigues Gisele Loth Gisele Loth Gisele Loth Samantha Nichele Samantha Nichele Cilmara Kuwahara Fernanda Moreira de Lara Benini Carolina Martins de Almeida Peixoto Juliana Bach Juliana Bach Joanna Trennepohl Lara Maria Miranda de Gouvea Lara Maria Miranda de Gouvea Rafaella Muratori Adriana Koliski Rebeca Toassa Gomes Marcia Quiroga Marcia Quiroga Simone Pereira Lermontov Valeria Gonçalves da Silva Ana Paula de Azambuja Margareth Kleina Feitosa Margareth Kleina Feitosa Alberto Cardoso Martins Lima Carmem Bonfim Carmem Bonfim |
| author_sort | Polliany Roberta Dorini Pelegrina |
| collection | DOAJ |
| description | BackgroundHematopoietic cell transplantation (HCT) represents a well-established therapeutic strategy for high-risk leukemia, though post-transplant relapse remains a significant challenge, particularly in resource-limited settingsProcedureIn this retrospective study, we analyzed medical records of 310 pediatric patients (age < 18 years) who underwent HCT for acute leukemias at four Brazilian institutions between 2010 and 2019.ResultsThe cohort included patients with acute lymphoblastic leukemia (ALL; 74.2%) and acute myeloid leukemia (AML; 25.8%). The median age was 9.52 years (range: 0.25–17.97), with male predominance (68.3%). Total body irradiation (TBI)-based conditioning was utilized in 72.6% of cases, and bone marrow served as the predominant graft source (74.5%). Prior to transplantation, 46.5% of patients were in first complete remission. Post-transplant relapse occurred in 36.7% of patients at a median of 245 days (range: 38–2,505). With a median follow-up of 2,019 days (5.5 years), overall survival was 69.3% at one year, declining to 62.4% at two years. The cumulative incidence of relapse was 12.6%, 28.8%, and 33.4% at 100 days, one year, and two years post-HCT, respectively. Adjusted analysis revealed increased relapse risk in patients with mixed donor chimerism, positive minimal residual disease (MRD) status before HCT, and disease status beyond first complete remission (including CR2, advanced disease, and refractory disease).Conclusion(s)These findings underscore the elevated relapse risk associated with advanced disease status, positive pre-HCT MRD, and mixed donor chimerism post-transplant. Future interventions should prioritize improving diagnostic capabilities, expanding access to modern treatment protocols, and facilitating early referral to transplant centers, particularly for aggressive disease presentations. |
| format | Article |
| id | doaj-art-5f1b92fac9b14f1d9193d79ef4a667db |
| institution | DOAJ |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-5f1b92fac9b14f1d9193d79ef4a667db2025-08-20T02:50:48ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-03-011310.3389/fped.2025.15733341573334Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experiencePolliany Roberta Dorini Pelegrina0Polliany Roberta Dorini Pelegrina1Rita de Cassia Barbosa Tavares2Adriana Mello Rodrigues3Adriana Mello Rodrigues4Adriana Mello Rodrigues5Gisele Loth6Gisele Loth7Gisele Loth8Samantha Nichele9Samantha Nichele10Cilmara Kuwahara11Fernanda Moreira de Lara Benini12Carolina Martins de Almeida Peixoto13Juliana Bach14Juliana Bach15Joanna Trennepohl16Lara Maria Miranda de Gouvea17Lara Maria Miranda de Gouvea18Rafaella Muratori19Adriana Koliski20Rebeca Toassa Gomes21Marcia Quiroga22Marcia Quiroga23Simone Pereira Lermontov24Valeria Gonçalves da Silva25Ana Paula de Azambuja26Margareth Kleina Feitosa27Margareth Kleina Feitosa28Alberto Cardoso Martins Lima29Carmem Bonfim30Carmem Bonfim31Pequeno Príncipe College, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilNational Cancer Institute (INCA), Rio de Janeiro, Rio de Janeiro, BrazilPequeno Príncipe College, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilPequeno Príncipe College, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilBone Marrow Transplant Unit, Hospital Nossa Senhora das Graças, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilPequeno Príncipe College, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilBone Marrow Transplant Unit, Hospital Nossa Senhora das Graças, Curitiba, Paraná, BrazilBone Marrow Transplant Unit, Hospital Nossa Senhora das Graças, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilNational Cancer Institute (INCA), Rio de Janeiro, Rio de Janeiro, BrazilNational Cancer Institute (INCA), Rio de Janeiro, Rio de Janeiro, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilHospital de Clínicas—UFPR, Curitiba, Paraná, BrazilPequeno Príncipe College, Curitiba, Paraná, BrazilHospital Pequeno Príncipe, Curitiba, Paraná, BrazilBackgroundHematopoietic cell transplantation (HCT) represents a well-established therapeutic strategy for high-risk leukemia, though post-transplant relapse remains a significant challenge, particularly in resource-limited settingsProcedureIn this retrospective study, we analyzed medical records of 310 pediatric patients (age < 18 years) who underwent HCT for acute leukemias at four Brazilian institutions between 2010 and 2019.ResultsThe cohort included patients with acute lymphoblastic leukemia (ALL; 74.2%) and acute myeloid leukemia (AML; 25.8%). The median age was 9.52 years (range: 0.25–17.97), with male predominance (68.3%). Total body irradiation (TBI)-based conditioning was utilized in 72.6% of cases, and bone marrow served as the predominant graft source (74.5%). Prior to transplantation, 46.5% of patients were in first complete remission. Post-transplant relapse occurred in 36.7% of patients at a median of 245 days (range: 38–2,505). With a median follow-up of 2,019 days (5.5 years), overall survival was 69.3% at one year, declining to 62.4% at two years. The cumulative incidence of relapse was 12.6%, 28.8%, and 33.4% at 100 days, one year, and two years post-HCT, respectively. Adjusted analysis revealed increased relapse risk in patients with mixed donor chimerism, positive minimal residual disease (MRD) status before HCT, and disease status beyond first complete remission (including CR2, advanced disease, and refractory disease).Conclusion(s)These findings underscore the elevated relapse risk associated with advanced disease status, positive pre-HCT MRD, and mixed donor chimerism post-transplant. Future interventions should prioritize improving diagnostic capabilities, expanding access to modern treatment protocols, and facilitating early referral to transplant centers, particularly for aggressive disease presentations.https://www.frontiersin.org/articles/10.3389/fped.2025.1573334/fullpediatricALLAMLBMTrelapse |
| spellingShingle | Polliany Roberta Dorini Pelegrina Polliany Roberta Dorini Pelegrina Rita de Cassia Barbosa Tavares Adriana Mello Rodrigues Adriana Mello Rodrigues Adriana Mello Rodrigues Gisele Loth Gisele Loth Gisele Loth Samantha Nichele Samantha Nichele Cilmara Kuwahara Fernanda Moreira de Lara Benini Carolina Martins de Almeida Peixoto Juliana Bach Juliana Bach Joanna Trennepohl Lara Maria Miranda de Gouvea Lara Maria Miranda de Gouvea Rafaella Muratori Adriana Koliski Rebeca Toassa Gomes Marcia Quiroga Marcia Quiroga Simone Pereira Lermontov Valeria Gonçalves da Silva Ana Paula de Azambuja Margareth Kleina Feitosa Margareth Kleina Feitosa Alberto Cardoso Martins Lima Carmem Bonfim Carmem Bonfim Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience Frontiers in Pediatrics pediatric ALL AML BMT relapse |
| title | Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience |
| title_full | Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience |
| title_fullStr | Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience |
| title_full_unstemmed | Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience |
| title_short | Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience |
| title_sort | clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation a multicenter brazilian experience |
| topic | pediatric ALL AML BMT relapse |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1573334/full |
| work_keys_str_mv | AT pollianyrobertadorinipelegrina clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT pollianyrobertadorinipelegrina clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT ritadecassiabarbosatavares clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT adrianamellorodrigues clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT adrianamellorodrigues clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT adrianamellorodrigues clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT giseleloth clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT giseleloth clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT giseleloth clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT samanthanichele clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT samanthanichele clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT cilmarakuwahara clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT fernandamoreiradelarabenini clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT carolinamartinsdealmeidapeixoto clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT julianabach clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT julianabach clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT joannatrennepohl clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT laramariamirandadegouvea clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT laramariamirandadegouvea clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT rafaellamuratori clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT adrianakoliski clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT rebecatoassagomes clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT marciaquiroga clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT marciaquiroga clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT simonepereiralermontov clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT valeriagoncalvesdasilva clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT anapauladeazambuja clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT margarethkleinafeitosa clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT margarethkleinafeitosa clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT albertocardosomartinslima clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT carmembonfim clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience AT carmembonfim clinicaloutcomesandrelapsepatternsinpediatricacuteleukemiapatientsundergoinghematopoieticcelltransplantationamulticenterbrazilianexperience |