Prognostic factors and outcomes after second allo-HSCT in pediatric ALL: A PRSZT registry analysis

Results from a retrospective, multicenter analysis of the Pediatric Registry for Stem Cell Transplantation (PRSZT), evaluating prognostic factors influencing survival and relapse after second allogeneic hematopoietic stem cell transplantation (allo-HSCT2) in pediatric patients with acute lymphoblastic leukemia (ALL; N = 75), were published in Pediatric Blood & Cancer by Momm et al.  

Key data: With a median follow-up of 2.23 years post-allo‑HSCT2, the overall survival (OS) rates at 1, 2, and 5 years were 57.7%, 48.0%, and 40.0%, respectively; corresponding relapse-free survival (RFS) rates were 49.7%, 35.2%, and 29.9%. Relapse occurred in 36% of patients at a median interval of 8.2 months. In multivariate analysis, age ≥10 years and precursor T‑cell ALL predicted inferior OS (hazard ratio [HR], 2.78; p = 0.009 and HR, 6.62; p = 0.001) and RFS (HR, 2.20; p = 0.029 and HR, 3.89; p < 0.005), while male sex (HR, 0.35; p = 0.02) and antithymocyte globulin (ATG) administration during allo-HSCT2 (HR, 0.35; p = 0.019) predicted improved OS. 

Key learning: Allo-HSCT2 remains a potentially curative option for selected pediatric patients with ALL after prior transplantation, particularly those with precursor B‑cell ALL and age <10 years, highlighting the need for improved patient selection and integration of novel immunotherapeutic strategies to further improve outcomes in this setting.