scholarly journals The incidence of symptomatic osteonecrosis after allogeneic haematopoietic stem cell transplantation in children with acute lymphoblastic leukaemia – controversy on dexamethasone as a risk factor

2018 ◽  
Vol 185 (5) ◽  
pp. 958-959 ◽  
Author(s):  
Reo Tanoshima ◽  
Bruce C. Carleton
Keyword(s):  
Risk Factor ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Acute Lymphoblastic Leukaemia ◽  
Cell Transplantation ◽  
Lymphoblastic Leukaemia ◽  
Haematopoietic Stem Cell Transplantation ◽  
Haematopoietic Stem Cell

scholarly journals Haematopoietic Stem Cell Transplantation in Adolescents and Young Adults With Acute Lymphoblastic Leukaemia: Special Considerations and Challenges

2022 ◽  
Vol 9 ◽  
Author(s):  
Charlotte Calvo ◽  
Leila Ronceray ◽  
Nathalie Dhédin ◽  
Jochen Buechner ◽  
Anja Troeger ◽  
...  
Keyword(s):  
Young Adults ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Acute Lymphoblastic Leukaemia ◽  
Cell Transplantation ◽  
Patient Group ◽  
Lymphoblastic Leukaemia ◽  
Haematopoietic Stem Cell Transplantation ◽  
Adolescents And Young Adults ◽  
Haematopoietic Stem Cell

Adolescents and young adults (AYAs) represent a challenging group of acute lymphoblastic leukaemia (ALL) patients with specific needs. While there is growing evidence from comparative studies that this age group profits from intensified paediatric-based chemotherapy, the impact and optimal implementation of haematopoietic stem cell transplantation (HSCT) in the overall treatment strategy is less clear. Over recent years, improved survival rates after myeloablative allogeneic HSCT for ALL have been reported similarly for AYAs and children despite differences in transplantation practise. Still, AYAs appear to have inferior outcomes and an increased risk of treatment-related morbidity and mortality in comparison with children. To further improve HSCT outcomes and reduce toxicities in AYAs, accurate stratification and evaluation of additional or alternative targeted treatment options are crucial, based on specific molecular and immunological characterisation of ALL and minimal residual disease (MRD) assessment during therapy. Age-specific factors such as increased acute toxicities and poorer adherence to treatment as well as late sequelae might influence treatment decisions. In addition, educational, social, work, emotional, and sexual aspects during this very crucial period of life need to be considered. In this review, we summarise the key findings of recent studies on treatment approach and outcomes in this vulnerable patient group after HSCT, turning our attention to the different approaches applied in paediatric and adult centres. We focus on the specific needs of AYAs with ALL regarding social aspects and supportive care to handle complications as well as fertility issues. Finally, we comment on potential areas of future research and concisely debate the capacity of currently available immunotherapies to reduce toxicity and further improve survival in this challenging patient group.

scholarly journals Impact of Early Chimerism Status on Clinical Outcome in Children with Acute Lymphoblastic Leukaemia after Haematopoietic Stem Cell Transplantation

2019 ◽  
Author(s):  
Monika Lejman ◽  
Agnieszka Zaucha-Prażmo ◽  
Joanna Zawitkowska ◽  
Aleksandra Mroczkowska ◽  
Dominik Grabowski ◽  
...  
Keyword(s):  
Stem Cell ◽  
Clinical Outcome ◽  
Stem Cell Transplantation ◽  
Acute Lymphoblastic Leukaemia ◽  
Cell Transplantation ◽  
Lymphoblastic Leukaemia ◽  
Haematopoietic Stem Cell Transplantation ◽  
Haematopoietic Stem Cell ◽  
Mixed Chimerism ◽  
Donor Chimerism

Abstract Background: The significance of very early chimerism assessment before day +28, which is considered the moment of engraftment, is still unclear. In this retrospective study, we evaluated the clinical impact of very early chimerism on the clinical outcome after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in children with acute lymphoblastic leukaemia (ALL). Methods: The study group included 38 boys and 18 girls. Very early chimerism was evaluated on days +7, +14, +21 and +28 after the transplant. Short tandem repeat polymerase chain reaction (STR PCR) was used to analyse chimerism. Results: Overall survival (OS) and event-free survival (EFS) were 84% and 80%, respectively. OS in the group of 24 patients with complete donor chimerism on day +14 was 83%, and it did not differ statistically compared to the 32 patients with mixed chimerism on day +14 (OS was 84%). The donor type (matched unrelated) and sex (male), number of transplanted cells (above 4.47 x 10 6 kg; on day +14) and serotherapy (without anti-thymocyte globulin)ATG were statistically related to a higher level of donor chimerism. Acute graft versus host disease grades II-IV was diagnosed in 23 patients who presented with donor chimerism levels above 60% on day 7. Conclusion: The data presented in this study provide valuable insight into the analysis of very early chimerism in children with ALL treated with HSCT.

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