Outcome of children with multiply relapsed B-cell acute lymphoblastic leukemia: a therapeutic advances in childhood leukemia & lymphoma study.
Sun WCity of Hope National Medical Center, Duarte, CA, USA. weilisun@coh.org.
Malvar JChildren's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Sposto RChildren's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Verma APrimary Children's Hospital, Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT, USA.
Wilkes JJSeattle Children's Hospital, University of Washington, Seattle, WA, USA.
Dennis RNationwide Children's Hospital, the Ohio State University, Columbus, OH, USA.
Heym KCook Children's Medical Center, Fort Worth, TX, USA.
Laetsch TWUT Southwestern Medical Center/ Children's Health, Dallas, TX, USA.
Widener MCenter for Cancer & Blood Disorders, Children's Hospital Colorado, Aurora, CO, USA.
Rheingold SRChildren's Hospital of Philadelphia, Philadelphia, PA, USA.
Oesterheld JLevine Children's Hospital at Carolinas Medical Center, Charlotte, NC, USA.
Hijiya NAnn & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Sulis MLNew York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Huynh VChildren's Hospital Orange County, Hyundai Cancer Institute, Orange, CA, USA.
Place AEDana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA.
Bittencourt HCHU Sainte-Justine, Universite de Montreal, Montreal, QC, Canada.
Hutchinson RC.S Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Messinger YChildren's Hospital of Minnesota, Minneapolis, MN, USA.
Chang BDoernbecher Children's Hospital, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
Matloub YRainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Ziegler DSKids Cancer Center, Sydney Children's Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
Gardner RSeattle Children's Hospital, University of Washington, Seattle, WA, USA.
Cooper TSeattle Children's Hospital, University of Washington, Seattle, WA, USA.
Ceppi FDepartment of Pediatrics, University of Lausanne, Lausanne, Switzerland.
Hermiston MBenioff Children's Hospital, University of California, San Francisco, CA, USA.
Dalla-Pozza LCancer Center for Children, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Schultz KRBC Children's Hospital and Research Institute, University of British Columbia, Vancouver, BC, Canada.
Gaynon PChildren's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Wayne ASChildren's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Whitlock JAThe Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
English
The survival of pediatric patients with multiply relapsed and/or refractory (R/R) B-cell acute lymphoblastic leukemia has historically been very poor; however, data are limited in the current era. We conducted a retrospective study to determine the outcome of multiply R/R childhood B-ALL treated at 24 TACL institutions between 2005 and 2013. Patient information, treatment, and response were collected. Prognostic factors influencing the complete remission (CR) rate and event-free survival (EFS) were analyzed. The analytic set included 578 salvage treatment attempts among 325 patients. CR rates (mean ± SE) were 51 ± 4% for patients with bone marrow R/R B-ALL who underwent a second salvage attempt, 37 ± 6% for a third attempt, and 31 ± 6% for the fourth through eighth attempts combined. For patients achieving a CR after their second, third, and fourth through eighth attempts, the 2 year EFS was 41 ± 6%, 13 ± 7%, and 27 ± 13% respectively. Our results showed slight improvement when compared to previous studies. This is the largest and most recent study to date that evaluates the outcome of this patient population. Our data will provide detailed reference for the evaluation of new agents being developed for childhood B-ALL.