{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:48Z","timestamp":1784527428340,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The clinical efficacy and prognostic factors of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) as a salvage approach for children with relapsed acute leukemia (AL) after a first allogeneic HSCT (allo-HSCT) remain unclear. This study aimed to evaluate the clinical efficacy, survival outcomes, and prognostic factors of second haploidentical HSCT in children with relapsed AL following prior allo-HSCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 40 pediatric patients (median age: 8.5 years) who underwent a second haplo-HSCT at two Chinese transplantation centers between January 2017 and December 2023. The primary endpoints were overall survival (OS) and leukemia-free survival (LFS); and secondary endpoints included cumulative relapse incidence and non-relapse mortality (NRM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>With a median follow-up of 16.0 months, 1- and 2-year OS rates were 77.8% and 65.5%, and LFS rates were 72.4% and 61.0%, respectively. The 2-year cumulative incidences of relapse and NRM were 26.6% and 15.1%, respectively. Multivariate analysis showed that B-cell acute lymphoblastic leukemia was associated with the most favorable 2-year OS (HR\u00a0=\u00a00.081, 95%CI: 0.007\u20130.877, P\u00a0=\u00a00.039). Grade III\u2013IV acute GVHD occurred in 25.0% of patients, and chronic GVHD occurred in 50.0% (10.0% extensive).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that second haplo-HSCT with myeloablative conditioning may be a viable and effective salvage option for pediatric patients with relapsed AL lacking matched donors, possibly through graft-versus-leukemia effects. Future studies should incorporate targeted therapies and immune modulation strategies to improve outcomes in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1885224","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:36:21Z","timestamp":1784525781000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes and predictors of second haploidentical hematopoietic stem cell transplantation for pediatric acute leukemia relapsing after a first allograft"],"prefix":"10.3389","volume":"17","author":[{"given":"Kai","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Hematology and Oncology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, 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Transplantation","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhang","family":"Feng","sequence":"additional","affiliation":[{"name":"Peking University People\u2019s Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingxi","family":"Zuo","sequence":"additional","affiliation":[{"name":"Peking University People\u2019s Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Bai","sequence":"additional","affiliation":[{"name":"Peking University People\u2019s Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Suo","sequence":"additional","affiliation":[{"name":"Peking University People\u2019s Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingbo","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Peking University People\u2019s Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Huang","sequence":"additional","affiliation":[{"name":"Peking University People\u2019s Hospital & Peking University Institute of 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