title: Childhood acute myeloid leukemia: outcome in a single center using chemotherapy and consolidation with busulfan/cyclophosphamide for bone marrow transplantation.
abstract: OBJECTIVE
  To report the impact of bone marrow transplantation (BMT) with busulfan/cyclophosphamide (BuCy) as end consolidation in a cohort of consecutively diagnosed children with acute myeloid leukemia (AML).
  
  
  METHODS
  Between May 1987 and November 1992, 43 patients were diagnosed with AML. Tissue typing at diagnosis determined whether patients would proceed to autologous or allogeneic BMT as end consolidation after six cycles of chemotherapy. Conditioning for BMT was with BuCy, followed by allogeneic or unpurged autologous marrow infusion.
  
  
  RESULTS
  Of 37 patients who received chemotherapy, 35 achieved remission (95%) after one to six courses of treatment and 34 (92%) were transplanted. Five relapsed before BMT, four were subsequently transplanted in second complete remission (CR2) (n = 3) or untreated first relapse (n = 1), and one failed to respond to further therapy. All other patients proceeded to BMT in first complete remission (CR1). Eleven patients received allografts: one relapsed and one died of graft-versus-host disease (GvHD), for a leukemia-free survival rate of 90% at a median of 41 months after BMT (range, 3 to 60). For 23 autografts, there were two toxic deaths and eight relapses, with a leukemia-free survival rate of 61% at a median of 11 months after BMT (range, 0 to 66). The high relapse rate following autologous BMT led us to escalate the dose of Bu from 16 mg/kg to 600 mg/m2 using a single daily dose of Bu.
  
  
  CONCLUSIONS
  With modern supportive therapy, most newly diagnosed children with AML will enter remission and are eligible for intensification therapy. BuCy is well tolerated in children, which allowed us to escalate the dose of Bu in recent patients. Further follow-up is needed to determine whether this has an impact on the relapse rate following autologous BMT.
authors.affiliation: Department of Oncology, Royal Alexandra Hospital for Children, Camperdown, Sydney, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Shaw
authors.forename: M E
authors.initials: ME
authors.lastname: Bergin
authors.forename: M A
authors.initials: MA
authors.lastname: Burgess
authors.forename: L
authors.initials: L
authors.lastname: Dalla Pozza
authors.forename: S J
authors.initials: SJ
authors.lastname: Kellie
authors.forename: G
authors.initials: G
authors.lastname: Rowell
authors.forename: M M
authors.initials: MM
authors.lastname: Stevens
authors.forename: B H
authors.initials: BH
authors.lastname: Webster
authors.forename: K F
authors.initials: KF
authors.lastname: Bradstock
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012074:Remission Induction
chemical_list: D003520:Cyclophosphamide; D002066:Busulfan