title: Allogeneic bone marrow transplantation versus chemotherapy in the treatment of childhood acute lymphoblastic leukemia in second complete remission.
abstract: Seventy-six patients between the ages of 2 and 17 years with acute lymphoblastic leukemia (ALL) achieved a second complete remission induced by polychemotherapy. Twenty-one had an HLA-identical donor and underwent allogeneic bone marrow transplantation (BMT) after conditioning with total body irradiation and cyclophosphamide. The remaining 55 patients lacked a suitable donor and received intensive chemotherapy as treatment. Fifteen patients were excluded from the analysis because they relapsed within 3 months after achieving a second complete remission. Three of the 21 BMT patients died of transplant-related complications and seven relapsed between 90 and 480 days after transplantation. Eleven patients are alive and disease free at 5.5-71 months with an actuarial survival of 47.1%; eight patients are on a plateau extending from 22 to 71 months. Thirty-three patients treated with chemotherapy died from relapse and seven are alive and disease free 7.5-99 months from the second remission, with an actuarial survival of 9%. The probability of survival was significantly higher in the BMT group (p less than 0.025). The probability of remaining in complete remission in the BMT group was 58.5% versus 10.9% in the chemotherapy group (p less than 0.005). Our results show that BMT is the best alternative therapy for children affected by ALL who have had a relapse in the marrow.
authors.affiliation: Department of Haematology of Cordoba, Sevilla, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: F
authors.initials: F
authors.lastname: Martínez
authors.forename: P
authors.initials: P
authors.lastname: Gómez
authors.forename: G
authors.initials: G
authors.lastname: Fornés
authors.forename: R
authors.initials: R
authors.lastname: Rojas
authors.forename: C
authors.initials: C
authors.lastname: Herrera
authors.forename: J L
authors.initials: JL
authors.lastname: Gómez
authors.forename: R
authors.initials: R
authors.lastname: Manzanares
authors.forename: J M
authors.initials: JM
authors.lastname: García
authors.forename: P
authors.initials: P
authors.lastname: Andres
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011788:Quality of Life; D016019:Survival Analysis
chemical_list: D006680:HLA Antigens