Keep in Mind Quality of Life: Outcome of a Ten-Year Series of Post-Transplantation Early Relapses in Childhood Acute Lymphoblastic Leukemia-A Report from the Grand Ouest Oncology Study Group for Children in France.

Acute lymphoblastic leukemia (ALL) relapses early after hematopoietic stem-cell transplants in children are uncommon, but associated with a very poor prognosis. Whereas there are no current recommendations for the management of these relapses, the children’s quality of life is an important issue. We studied the outcomes, including one-year overall survival, complete remission and quality of life, of 19 children with ALL who relapsed within the year following their transplant treated in the 5 participating centers between 2000 and 2011 Patients were distributed as follows: supportive care only (group A), outpatient treatment (mainly steroid and vincristine; group B) or intensive inpatient treatment (group C). There were no significant differences in one-year overall survival (31.5% for the entire cohort) or remission rate for time between transplant and relapse (<6 months or 6–12 months), transplant or disease characteristics or treatment group. However, time spent in hospital (for treatment and complications) significantly differed between treatment groups B and C (20.8%+/-13.0 versus 59.1% +/-32.9, respectively; p<0.05). No differences in organ toxicities, school attendance or Lansky score were found between treatment groups. Our sample size-limited data indicate, in a pre-personalized medicine era, that children treated with steroid and vincristine have the same prognosis as those treated with intensive therapy, but may benefit from improved quality of life. Nevertheless, new therapeutic strategies are required and future prospective trials would help to establish recommendations