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Salvage Treatment Options for Posttransplant Relapse in Children with Early/Very Early Relapse of Acute Lymphoblastic
Zühre Kaya1, Serap Kirkiz Kayalı1, Ahmet Bayramlı1
1Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
Insights
Targeted agents significantly improve survival and reduce toxicity for children with relapsed acute lymphoblastic leukemia (ALL) after stem cell transplant. These novel therapies offer a promising salvage treatment option for high-risk ALL patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Stem Cell Transplantation
Background:
- Posttransplant relapse remains a critical challenge in pediatric acute lymphoblastic leukemia (ALL).
- Identifying effective salvage treatment options is crucial for improving outcomes in high-risk ALL patients.
Purpose of the Study:
- To evaluate and compare the efficacy and toxicity of purine nucleoside analogs versus targeted agents as salvage treatment for posttransplant relapse in pediatric ALL.
Main Methods:
- Retrospective analysis of 40 high-risk pediatric ALL patients with early/very early relapse post-hematopoietic stem cell transplant.
- Group 1 (n=9) received purine nucleoside analogs (fludarabine/clofarabine-based).
- Group 2 (n=8) received targeted agents (Blinatumomab, Bortezomib, CART).
Main Results:
- Group 2 demonstrated a significantly higher cumulative survival rate (75% vs 22%) compared to Group 1 (p<0.05).
- Group 2 experienced significantly lower rates of grade 3 and 4 toxicity (13% vs 66%).
Conclusions:
- Targeted agents show promise as an effective salvage treatment for posttransplant relapse in high-risk pediatric ALL.
- These findings suggest targeted agents may be recommended for this patient population, warranting further investigation.
Abstract:
This study aimed to evaluate salvage treatment options for posttransplant relapse in children with early/very early relapse of acute lymphoblastic leukemia (ALL). Forty consecutive high-risk ALL cases were divided into two groups based on the salvage treatment for posttransplant relapse: Group 1 (n=9) received purine nucleoside analogs (fludarabine/clofarabine-based regimens), while Group 2 (n=8) received targeted agents (blinatumomab, bortezomib, and chimeric antigen receptor T-cells). In Group 1, seven children received a fludarabine-based regimen and two received a clofarabine-based regimen. In Group 2, five children received bortezomib-based regimens, two received blinatumomab, and one received chimeric antigen receptor T-cells. Group 2 showed a significantly higher cumulative survival rate (75% vs. 22%) and lower grade 3 and 4 toxicity rates (13% vs. 66%) compared to Group 1 (p<0.05). Based on our limited data, targeted agents may constitute an effective treatment option and can be directly recommended for posttransplant relapse in children with high-risk ALL.
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