Abstract |
Hematopoietic stem cell transplantation (HSCT) remains the only curative option for most patients with juvenile myelomonocytic leukemia (JMML). However, persistent disease and relapse rates after transplant range from 26% to 58%. We report the successful use of second HSCT after preparation with mitoxantrone and cytosine arabinoside ( Ara-C) for patients with refractory or recurrent disease. Between 1993 and 2006, 5 children who underwent HSCT at our institution as initial therapy for JMML had persistent disease or relapsed. Pre-HSCT conditioning varied and donors were either HLA-matched siblings (n=2) or matched unrelated donors (n=3). After initial HSCT, they subsequently received high-dose Ara-C (3 g/m IV) every 12 hours on days -8 through -3 and mitoxantrone (10 mg/m/d IV) on days -8, -7, -6 followed by second HSCT from their original donors. All 5 patients are alive at 88, 179, 199, 234, and 246 months with no evidence of JMML, no significant toxicity, and 100% donor chimera as determined by PCR short-tandem repeat analysis. Our experience supports second transplant utilizing high-dose Ara-C and mitoxantrone in children with JMML who do not respond or relapse after first transplant.
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Authors | Sachit A Patel, Don W Coulter, Alfred C Grovas, Bruce G Gordon, James L Harper, Phyllis I Warkentin, James L Wisecarver, Warren G Sanger, Peter F Coccia |
Journal | Journal of pediatric hematology/oncology
(J Pediatr Hematol Oncol)
Vol. 36
Issue 6
Pg. 491-4
(Aug 2014)
ISSN: 1536-3678 [Electronic] United States |
PMID | 24322499
(Publication Type: Journal Article)
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Chemical References |
- Antimetabolites, Antineoplastic
- Cytarabine
- Mitoxantrone
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Topics |
- Antimetabolites, Antineoplastic
(administration & dosage)
- Child
- Child, Preschool
- Combined Modality Therapy
- Cytarabine
(administration & dosage)
- Disease-Free Survival
- Hematopoietic Stem Cell Transplantation
- Humans
- Infant
- Leukemia, Myelomonocytic, Juvenile
(drug therapy, therapy)
- Male
- Mitoxantrone
(administration & dosage)
- Recurrence
- Retreatment
- Tissue Donors
- Transplantation Chimera
- Transplantation Conditioning
(methods)
- Transplantation, Homologous
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