title: Allogeneic bone marrow transplantation vs chemotherapy for children with Philadelphia chromosome-positive acute lymphoblastic leukemia.
abstract: Allogeneic bone marrow transplant (BMT) with an MRD in complete remission (CR)1 is the preferred treatment for children with Philadelphia-positive (Ph(+)) ALL. The role of MUD BMT in CR1 is still controversial. We compared the outcomes of two treatment strategies: BMT using an MRD or MUD vs chemotherapy in children with Ph(+) ALL in CR1. In total, 21 children were treated from 1985 to 2001. In all, 10 received chemotherapy and 11 received allogeneic BMT: four MRD, seven MUD. In the MRD group, one relapsed 12 months after BMT and died; the remaining three are long-term event-free survivors (median follow-up, 6.1 years). In the MUD group four died; the remaining three are long-term event-free survivors (median follow-up, 7.2 years). The 4-year event-free survival (EFS) for the BMT group was 53+/-15%. In the chemotherapy group, seven relapsed after a median period of 12.5 months and three remain in continuous CR (median follow-up, 2.4 years). Four chemotherapy patients received CR2 transplants; all died. The 4-year EFS for the chemotherapy and MUD groups was 33+/-17 and 35.7+/-20%, respectively. This difference was not statistically significant. We continue to support treating children with Ph(+) ALL with MRD BMT in CR1. The effectiveness of MUD BMT vs chemotherapy merits further study.
authors.affiliation: The Hospital for Sick Children, Division of Hematology/Oncology, University of Toronto, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Sharathkumar
authors.forename: E F
authors.initials: EF
authors.lastname: Saunders
authors.forename: Y
authors.initials: Y
authors.lastname: Dror
authors.forename: R
authors.initials: R
authors.lastname: Grant
authors.forename: M
authors.initials: M
authors.lastname: Greenberg
authors.forename: S
authors.initials: S
authors.lastname: Weitzman
authors.forename: H
authors.initials: H
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Calderwood
authors.forename: M H
authors.initials: MH
authors.lastname: Freedman
authors.forename: J
authors.initials: J
authors.lastname: Doyle
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards* / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000401:mortality / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome