Hazar V, Karasu GT, Öztürk G, et al. - In children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), dismal prognosis has been recorded in correlation with post-transplant relapse. Researchers herein sought risk factors, treatment options, and outcomes in this study. They performed a retrospective multicenter study in which all pediatric transplant centers were sent a questionnaire to report relapse after allo-HSCT for a cohort of 938 children with acute leukemia; analysis was performed including 255 children with relapse of acute leukemia after their first allo-HSCT. The 3-year overall survival (OS) rate of 12.0% was observed. Disease progression or subsequent relapse (82.6%) was the main cause of death. Salvage treatment with curative intent without a second HSCT was provided to the majority of children (67.8%); 22.0% of children underwent a second allo-HSCT, and 10.2% received palliative therapy. Significant prognostic factors for outcome included isolated extramedullary relapse and relapse earlier than 365 days post-transplantation. In chemosensitive relapse, the type of salvage therapy was recognized as a significant prognostic factor for OS. For patients with post-transplant relapse, researchers suggest considering a salvage approach with curative intent, even if they relapse in the first year post-transplantation. For sustainable remission, they recommend considering a second allo-HSCT for patients who achieve complete remission after reinduction treatment.