{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:57:23Z","timestamp":1765976243342,"version":"3.48.0"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T00:00:00Z","timestamp":1757203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Relapsed or refractory cases of pediatric acute myeloid leukemia (AML) have poor outcomes despite advancements in chemotherapy and hematopoietic stem cell transplantation (HSCT). While a second HSCT is often a salvage option, its outcomes vary widely, and prognostic factors remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to evaluate outcomes and identify prognostic factors in pediatric patients with AML who underwent multiple HSCTs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, multicenter study of 49 pediatric patients with AML who underwent two or more HSCTs at 18 Japan Association of Childhood Leukemia Study institutions during 2000\u20132019. Clinical data on patient demographics, disease status, transplant characteristics, and complications were collected. The primary endpoint was 5\u2010year overall survival (OS) after the second HSCT. Kaplan\u2013Meier and multivariate Cox regression analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 49 patients, three and 46 underwent three and two HSCTs, respectively. Among these 46 patients, 5\u2010year OS after the second HSCT was 28.3%. Achieving hematological complete remission (CR) before the second HSCT was associated with significantly better outcomes (5\u2010year OS: 45.0% vs. 0%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01). Severe sinusoidal obstruction syndrome (SOS) after the second HSCT was a strong predictor of transplant\u2010related mortality (5\u2010year OS: 0% in severe SOS cases,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01). Patient age, donor type, conditioning regimen, and acute\/chronic graft\u2010versus\u2010host disease were not significantly associated with survival in multivariate analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Achieving CR before the second HSCT is critical for long\u2010term survival, while severe SOS significantly worsens prognosis. Optimized pre\u2010transplant strategies to reduce SOS risk are essential to improve outcomes of pediatric patients with AML who undergo multiple HSCTs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.32036","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T03:39:01Z","timestamp":1757302741000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multiple Hematopoietic Stem Cell Transplantations in Pediatric Acute Myeloid Leukemia: Prognostic Significance of Remission and Severe Sinusoidal Obstruction Syndrome"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8140-627X","authenticated-orcid":false,"given":"Hideki","family":"Yoshida","sequence":"first","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Pediatrics Kyoto Prefectural University of Medicine  Kyoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shotaro","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Total Care Center for AYA with Cancer and Children Mie University Hospital  Tsu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Shimada","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Pediatrics Jichi Children's Medical Center Tochigi  Shimono Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takako","family":"Miyamura","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Pediatrics The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1294-8635","authenticated-orcid":false,"given":"Kiminori","family":"Terui","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Pediatrics Hirosaki University Hospital  Hirosaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4183-4602","authenticated-orcid":false,"given":"Hirozumi","family":"Sano","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Hematology\/Oncology for Children and Adolescents Sapporo Hokuyu Hospital  Sapporo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihiro","family":"Tamura","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Pediatrics Kobe University Hospital  Kobe Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3686-9915","authenticated-orcid":false,"given":"Yoko","family":"Mizoguchi","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Pediatrics Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyoko","family":"Moritani","sequence":"additional","affiliation":[{"name":"Acute Myeloid Leukemia Sub\u2010Committee Association of Childhood Leukemia Study (JACLS) Japan"},{"name":"Department of Pediatrics Ehime University Hospital  Matsue 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