title: Unrelated donor bone marrow transplantation for children and adolescents with Philadelphia-positive acute lymphoblastic leukemia.
abstract: OBJECTIVE
  Few patients with Philadelphia-positive acute lymphoblastic leukemia (Ph-positive ALL) have been cured by chemotherapy alone. Registry figures show that 38% of patients who have a matched-sibling bone marrow transplant (BMT) are disease-free 2 years after transplant, but the majority of patients lack a sibling donor. Most modern ALL protocols recommend unrelated donor (UD) BMT for patients with Ph-positive ALL in first complete remission (CR1), but the outcome of this is unknown.
  
  
  METHODS
  We report the results of 15 children and adolescents who had a T-cell depleted UD-BMT for Ph-positive ALL. Thirteen of 15 had been previously treated on United Kingdom ALL protocols. Nine were in CR1 and six had more advanced disease. Eleven donor recipient pairs were matched at HLA-A, HLA-B, HLA-DR, and HLA-DQ, and four were mismatched at one or two HLA loci.
  
  
  RESULTS
  The incidence of greater than grade I acute and chronic graft-versus-host disease (GVHD) was low (13% and 8%, respectively). Six patients have relapsed and seven patients survive at a median of 21 months post-BMT; six of seven are disease free. All seven survivors are in full-time education or work. The 2-year overall and disease-free survivals are 44% +/- 13% and 37% +/- 13% (+/- SE). None of four patients who had mismatched donors survived, but seven of 11 matched recipients survive (P < .05).
  
  
  CONCLUSIONS
  UD-BMT can produce prolonged disease-free survival in young patients with Ph-positive ALL who otherwise would have an extremely poor outlook.
authors.affiliation: Bone Marrow Transplant Unit, Bristol Royal Hospital for Sick Children, England. dmarks@nildram.co.uk
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
authors.forename: J M
authors.initials: JM
authors.lastname: Bird
authors.forename: J M
authors.initials: JM
authors.lastname: Cornish
authors.forename: N J
authors.initials: NJ
authors.lastname: Goulden
authors.forename: C G
authors.initials: CG
authors.lastname: Jones
authors.forename: C J
authors.initials: CJ
authors.lastname: Knechtli
authors.forename: D H
authors.initials: DH
authors.lastname: Pamphilon
authors.forename: C G
authors.initials: CG
authors.lastname: Steward
authors.forename: A
authors.initials: A
authors.lastname: Oakhill
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease; D006680:HLA Antigens; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012074:Remission Induction; D016019:Survival Analysis; D014181:Transplantation Immunology
chemical_list: D006680:HLA Antigens