{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:03:42Z","timestamp":1785301422352,"version":"3.55.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"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. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background\/aims<\/jats:title>\n                    <jats:p>Optimal pre-transplant chemotherapy exposure for pediatric patients with high-risk acute myeloid leukemia (AML) in first complete remission (CR1) remains undefined. Many patients achieve measurable residual disease (MRD)-negative remission early, raising the question of whether additional chemotherapy prior to allogeneic hematopoietic cell transplantation (HCT) improves outcomes. We evaluated the impact of pre-HCT chemotherapy cycles on post-transplant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective single-center cohort study of pediatric patients (age 0\u201318 years) with high-risk AML undergoing first myeloablative allogeneic HCT in MRD-negative CR1 between 2011 and 2023. Patients were stratified by receipt of 1\u20132 versus 3\u20134 pre-HCT chemotherapy cycles. Patients in the 3\u20134 cycle cohort who had achieved MRD-negative remission by the end of cycle 2 were assessed and compared to the 1\u20132 cycle cohort for rates of two-year relapse-free survival (RFS) and cumulative incidence of relapse. All patients in both cohorts were assessed for rates of two-year overall survival (OS) and one-year non-relapse mortality (NRM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty patients met inclusion criteria; 22 (55%) received 1\u20132 cycles and 18 (45%) received 3\u20134 cycles. Excluding patients who were not MRD-negative after 2 cycles, two-year RFS was 66% (95% CI 32-86) for 3\u20134 cycles vs 68% (45-83) for 1\u20132 cycles (Hazard Ratio [HR] 0.88 [95% CI 0.26-3.01], p=0.84). The cumulative incidence of relapse at two years was 34% (9-62) in the 3\u20134 cycle cohort and 14% (3-31) in the 1\u20132 cycle cohort (HR 2.39 [0.57-10.1], p=0.23). Two-year OS was 77% (49-91) for 3\u20134 cycles vs 67% (46-84) in the 1\u20132 cycle cohort (HR 0.63 [0.18-2.14], p=0.46). One-year NRM was 0% in the 3\u20134 cycle group and 18% (5-37) in the 1\u20132 cohort (HR NE, p=0.06).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among pediatric patients with high-risk AML undergoing allogeneic HCT in MRD-negative CR1 at a single center, 3\u20134 pre-transplant chemotherapy cycles were not associated with statistically significant differences in overall or relapse-free survival compared to 1\u20132 cycles, although the study was underpowered to exclude clinically meaningful differences. Consolidation with HCT after 1\u20132 cycles of chemotherapy, once MRD-negative remission is achieved, warrants prospective exploration of risk- and remission-guided treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1881569","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:46:40Z","timestamp":1785300400000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of pre-transplant chemotherapy cycles on allogeneic hematopoietic cell transplant outcomes in pediatric acute myeloid leukemia in first complete remission"],"prefix":"10.3389","volume":"16","author":[{"given":"Aaron","family":"Ackerman","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christen L.","family":"Ebens","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy C.","family":"Lund","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret L.","family":"MacMillan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aswin Jayaraaman","family":"Chandrasekaran","sequence":"additional","affiliation":[{"name":"Biostatistics Core, Masonic Cancer Center, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Shanley","sequence":"additional","affiliation":[{"name":"Biostatistics Core, Masonic Cancer Center, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Krieger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Virginia Commonwealth University","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Hoover","sequence":"additional","affiliation":[{"name":"Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30584","article-title":"Children's Oncology Group's 2023 blueprint for research: Myeloid neoplasms","volume":"70","author":"Cooper","year":"2023","journal-title":"Pediatr Blood Cancer"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-02-408336","article-title":"Residual disease detected by multidimensional flow cytometry signifies high relapse risk in patients with de novo acute myeloid leukemia: a report from Children's 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