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Allogeneic bone marrow transplantation for leukemia in Europe: regional differences. Report from the Leukemia Working party of the European Group for Bone Marrow Transplantation.

https://arctichealth.org/en/permalink/ahliterature25241
Source
Bone Marrow Transplant. 1990 Mar;5(3):159-65
Publication Type
Article
Date
Mar-1990
Author
A. Gratwohl
J. Hermans
A J Barrett
P. Ernst
F. Frassoni
G. Gahrton
A. Granena
H J Kolb
H G Prentice
J P Vernant
Author Affiliation
Department of Internal Medicine, University Hospital Basel, Switzerland.
Source
Bone Marrow Transplant. 1990 Mar;5(3):159-65
Date
Mar-1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Bone Marrow Transplantation - mortality - statistics & numerical data
Chi-Square Distribution
Child
Child, Preschool
Comparative Study
Europe - epidemiology
Female
Graft vs Host Disease - prevention & control
Humans
Infant
Leukemia, Lymphocytic, Acute - mortality - surgery
Leukemia, Myelocytic, Acute - mortality - surgery
Leukemia, Myeloid, Chronic - mortality - surgery
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Retrospective Studies
Survival Rate
Abstract
The results of 1904 allogeneic HLA identical sibling donor bone marrow transplants performed in 52 European centers between 1979 and 1986 and reported to the EBMT leukemia registry were analysed by geographical location of the transplant. Patients were grouped into six regions: United Kingdom, Nordic Group, Benelux, France, Central Europe and Southern Europe. There were significant differences between these regions with respect to patient population and outcome. The relative proportion of the three major disease categories, stage and subtype of the diseases, graft-versus-host disease prevention methods, donor recipient sex combinations, age of the patient, year of the transplant and the time intervals from diagnosis to transplant, from diagnosis to first complete remission for acute leukemia and the time from first complete remission to the transplant varied from region to region. The analysis of outcome parameters showed a significant difference in relapse incidence from region to region. This influence of region was confirmed in a multivariate analysis and was independent of the other factors known to affect outcome. Leukemia-free survival and transplant-related mortality were not different. The reasons for these differences could not be explained by the data in the registry. We conclude that regional factors must be considered when bone marrow transplant data are compared and we postulate that pretransplant factors probably affect outcome more than was previously realized.
PubMed ID
2331536 View in PubMed
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Pathways through relapses and deaths of children with acute lymphoblastic leukemia: role of allogeneic stem-cell transplantation in Nordic data.

https://arctichealth.org/en/permalink/ahliterature79374
Source
J Clin Oncol. 2006 Dec 20;24(36):5750-62
Publication Type
Article
Date
Dec-20-2006
Author
Saarinen-Pihkala Ulla M
Heilmann Carsten
Winiarski Jacek
Glomstein Anders
Abrahamsson Jonas
Arvidson Johan
Békássy Albert N
Forestier Erik
Jonmundsson Gudmundur
Schroeder Henrik
Vettenranta Kim
Wesenberg Finn
Gustafsson Göran
Author Affiliation
Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. ulla.pihkala@hus.fi
Source
J Clin Oncol. 2006 Dec 20;24(36):5750-62
Date
Dec-20-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Antineoplastic Combined Chemotherapy Protocols - adverse effects - therapeutic use
Child
Child, Preschool
Drug Resistance, Neoplasm
Female
Hematopoietic Stem Cell Transplantation
Humans
Infant
Leukemia, Lymphocytic, Acute - mortality - surgery
Male
Recurrence
Retrospective Studies
Scandinavia - epidemiology
Transplantation, Homologous
Abstract
PURPOSE: Our focus was on patients with pediatric acute lymphoblastic leukemia (ALL) who experienced relapse or died without becoming transplantation candidates. The purpose was to outline measures needed to improve the outcome. PATIENTS AND METHODS: We analyzed our population-based 20-year data on 3,385 Nordic children with ALL treated on Nordic Society for Pediatric Hematology and Oncology ALL protocols, and described the flow of these patients through relapses, remissions, and deaths as a result of toxicity, demonstrating where major patient losses occurred. RESULTS: In total, 854 patients (25%) had a first and 274 patients (8%) had a second ALL relapse. P for survival after the first relapse was .35 +/- .02. The induction mortality (2.2%, primary; 10.3%, first relapse; 26.3%, second relapse) and remission mortality (1%, first complete remission [1CR]; 19%, second CR [2CR]) were significant; transplantation-related mortality (TRM) only represented 15% (69 of 459) of the deaths as a result of toxicity. Of the 766 patients entering 2CR, 29% underwent transplantation (P for survival, .46 +/- .04), whereas 71% continued receiving chemotherapy (P for survival, .39 +/- .02). Children with stem-cell transplantation indications in 2CR, if they did not undergo transplantation, generally died or had a second relapse. The patient groups that underwent transplantation in 1CR (n = 84), 2CR (n = 220), and > or = 3CR (n = 62) represented different risk profiles. Those with allogeneic stem-cell transplantation (allo-SCT) in > or = 3CR (P for survival, .37 +/- .07) had an ALL and first relapse with favorable features. CONCLUSION: Major patient losses occurred through mortality as a result of toxicity and resistant disease during the pathways before allo-SCT. After relapse, more patients were lost to mortality as a result of toxicity during conventional chemotherapy compared with TRM. After second relapse, the chance for rescue by allo-SCT in 3CR was minimal. The question of whether transplantation is recommended after ALL relapse should be carefully addressed, and more efficient relapse protocols should be launched.
PubMed ID
17179109 View in PubMed
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