title: Bone marrow transplantation for childhood acute lymphoblastic leukaemia after marrow relapse.
abstract: Children with acute lymphoblastic leukaemia in whom relapse in bone marrow occurs have a poor outlook when treated with chemotherapy alone. Twenty-seven patients with childhood acute lymphoblastic leukaemia were treated for marrow relapse with high-dose chemotherapy with or without total body irradiation followed by bone marrow transplantation (BMT). Twenty patients received allogeneic marrow from partially or completely matched histocompatible donors. In this group, nine patients (45%) were free of disease with a median follow-up of 57 months (range, 22 to 126 months) after transplantation, four (20%) died from interstitial pneumonitis and seven (35%) died after a further relapse. Seven patients received autologous marrow collected while they were in remission. In this group, one patient died from infection and six died after a further relapse. We conclude that allogeneic BMT is more effective than autologous transplantation and results in long-term disease-free survival in a significant number of patients. New methods are needed to eradicate residual disease in the patient and to purge marrow ex vivo.
authors.affiliation: Prince of Wales Children's Hospital, Randwick, NSW.
authors.forename: M R
authors.initials: MR
authors.lastname: Vowels
authors.forename: R
authors.initials: R
authors.lastname: Lam-Po-Tang
authors.forename: H
authors.initials: H
authors.lastname: Mameghan
authors.forename: D
authors.initials: D
authors.lastname: Ford
authors.forename: A
authors.initials: A
authors.lastname: Trickett
authors.forename: L
authors.initials: L
authors.lastname: White
authors.forename: G
authors.initials: G
authors.lastname: Marshall
authors.forename: R
authors.initials: R
authors.lastname: Brown
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous