ABSTRACT
Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach). If this was not feasible, low-dose chemotherapy and donor lymphocyte infusions (LDCHT+DLI) were offered (non-transplant approach). A total of 23 patients suffered a post-transplant relapse. Eight patients received HDCHT/SIT, followed by haploidentical SCT in 7/8. Ten received LDCHT+DLI. The eight patients treated with a second transplant and the ten treated with the non-transplant approach had a 4-year overall survival of 56% and 40%, respectively (P=0.232). Prerequisites for successful treatment of post-transplant relapse by either a second transplant or experimental non-transplant approaches are good clinical condition and the capacity to achieve haematological remission by the induction treatment element.
Subject(s)
Immunotherapy , Lymphocyte Transfusion , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Stem Cell Transplantation , Tissue Donors , Adolescent , Allografts , Child , Child, Preschool , Female , Germany , Humans , Infant , Male , Recurrence , Retrospective StudiesSubject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Neoplasms, Second Primary/etiology , Pelvic Neoplasms/etiology , Sarcoma/etiology , beta-Thalassemia/therapy , Child , Homozygote , Humans , Male , Neoplasm Staging , Neoplasms, Second Primary/diagnosis , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/therapy , Pelvic Neoplasms/diagnosis , Pelvic Neoplasms/pathology , Pelvic Neoplasms/therapy , Remission Induction , Sarcoma/diagnosis , Sarcoma/pathology , Sarcoma/therapy , beta-Thalassemia/geneticsABSTRACT
While a paediatric dosage has not been defined, posaconazole is occasionally being used in children. We conducted a multicentre retrospective survey and identified 15 patients (median age 10 years [range 3.6-17.5]) who received posaconazole salvage therapy for proven (9 patients) or probable (6 patients) invasive fungal infections. Posaconazole was administered for a median of 32 days (range 4-262) at a median dosage of 21 mg/kg (range 4.8-33.3). None of the patients discontinued therapy due to adverse events, which were mostly mild and observed in 11 patients. Complete or partial responses were observed in 4/7 patients with zygomycosis, 3/4 patients with invasive mould infection, 1/2 patients with invasive aspergillosis and 1/2 patients with chronic disseminated candidiasis. We conclude from the data that posaconazole displays favourable safety and tolerance and may be useful for management of individual paediatric patients with invasive infections.