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. 2025 Mar 20:13:1573334.
doi: 10.3389/fped.2025.1573334. eCollection 2025.

Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience

Polliany Roberta Dorini Pelegrina  1   2 , Rita de Cassia Barbosa Tavares  3 , Adriana Mello Rodrigues  1   2   4 , Gisele Loth  1   2   4 , Samantha Nichele  4   5 , Cilmara Kuwahara  2 , Fernanda Moreira de Lara Benini  2 , Carolina Martins de Almeida Peixoto  2 , Juliana Bach  1   2 , Joanna Trennepohl  4 , Lara Maria Miranda de Gouvea  4   5 , Rafaella Muratori  5 , Adriana Koliski  4 , Rebeca Toassa Gomes  4 , Marcia Quiroga  2   4 , Simone Pereira Lermontov  3 , Valeria Gonçalves da Silva  3 , Ana Paula de Azambuja  4 , Margareth Kleina Feitosa  2   4 , Alberto Cardoso Martins Lima  4 , Carmem Bonfim  1   2
Affiliations

Clinical outcomes and relapse patterns in pediatric acute leukemia patients undergoing hematopoietic cell transplantation: a multicenter Brazilian experience

Polliany Roberta Dorini Pelegrina et al. Front Pediatr. .

Abstract

Background: Hematopoietic cell transplantation (HCT) represents a well-established therapeutic strategy for high-risk leukemia, though post-transplant relapse remains a significant challenge, particularly in resource-limited settings.

Procedure: In this retrospective study, we analyzed medical records of 310 pediatric patients (age < 18 years) who underwent HCT for acute leukemias at four Brazilian institutions between 2010 and 2019.

Results: The cohort included patients with acute lymphoblastic leukemia (ALL; 74.2%) and acute myeloid leukemia (AML; 25.8%). The median age was 9.52 years (range: 0.25-17.97), with male predominance (68.3%). Total body irradiation (TBI)-based conditioning was utilized in 72.6% of cases, and bone marrow served as the predominant graft source (74.5%). Prior to transplantation, 46.5% of patients were in first complete remission. Post-transplant relapse occurred in 36.7% of patients at a median of 245 days (range: 38-2,505). With a median follow-up of 2,019 days (5.5 years), overall survival was 69.3% at one year, declining to 62.4% at two years. The cumulative incidence of relapse was 12.6%, 28.8%, and 33.4% at 100 days, one year, and two years post-HCT, respectively. Adjusted analysis revealed increased relapse risk in patients with mixed donor chimerism, positive minimal residual disease (MRD) status before HCT, and disease status beyond first complete remission (including CR2, advanced disease, and refractory disease).

Conclusions: These findings underscore the elevated relapse risk associated with advanced disease status, positive pre-HCT MRD, and mixed donor chimerism post-transplant. Future interventions should prioritize improving diagnostic capabilities, expanding access to modern treatment protocols, and facilitating early referral to transplant centers, particularly for aggressive disease presentations.

Keywords: ALL; AML; BMT; pediatric; relapse.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overall survival, disease-free survival after HCT for pediatric patients with acute leukemias and incidence of relapse after HCT according to the disease phase and overall survival according to and time to relapse after transplant. (A) Probability of OS by disease phase, (B) Probability of DFS by disease phase, (C) Incidence of relapse by disease phase, (D) Probability of OS by time to relapse.
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