Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research.
The best treatment approach for children with B-precursor acute lymphoblastic leukemia (ALL) in second clinical remission (CR) after a marrow relapse is controversial. To address this question, we compared outcomes in 188 patients enrolled in chemotherapy trials and 186 HLA-matched sibling transplants, treated between 1991 and 1997. Groups were similar except that chemotherapy recipients were younger (median age, 5 versus 8 years) and less likely to have combined marrow and extramedullary relapse (19% versus 30%). To adjust for time-to-transplant bias, treatment outcomes were compared using left-truncated Cox regression models. The relative efficacy of chemotherapy and transplantation depended on time from diagnosis to first relapse and the transplant conditioning regimen used. For children with early first relapse (< 36 months), risk of a second relapse was significantly lower after total body irradiation (TBI)-containing transplant regimens (relative risk [RR], 0.49; 95% confidence interval [CI] 0.33-0.71, P < .001) than chemotherapy regimens. In contrast, for children with a late first relapse (> or = 36 months), risks of second relapse were similar after TBI-containing regimens and chemotherapy (RR, 0.92; 95% CI, 0.49-1.70, P = .78). These data support HLA-matched sibling donor transplantation using a TBI-containing regimen in second CR for children with ALL and early relapse.
Eapen
Mary
M
Statistical Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA. meapen@mcw.edu
Raetz
Elizabeth
E
Zhang
Mei-Jie
MJ
Muehlenbein
Catherine
C
Devidas
Meenakshi
M
Abshire
Thomas
T
Billett
Amy
A
Homans
Alan
A
Camitta
Bruce
B
Carroll
William L
WL
Davies
Stella M
SM
D000293:Adolescent; D001853:Bone Marrow / Q000473:pathology; D002051:Burkitt Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005260:Female; D006650:Histocompatibility Testing; D006761:Hospitals; D006801:Humans; D007223:Infant; D019520:Living Donors; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D035781:Siblings; D033581:Stem Cell Transplantation / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome