title: Outcomes after HLA-matched sibling transplantation or chemotherapy in children with acute lymphoblastic leukemia in a second remission after an isolated central nervous system relapse: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research.
abstract: In children with acute lymphoblastic leukemia (ALL) with isolated central nervous system (CNS) relapse and a human leucocyte antigen (HLA)-matched sibling, the optimal treatment after attaining second remission is unknown. We compared outcomes in 149 patients enrolled on chemotherapy trials and 60 HLA-matched sibling transplants, treated in 1990-2000. All patients achieved a second complete remission. Groups were similar, except the chemotherapy recipients were younger at diagnosis, less likely to have T-cell ALL and had longer duration (> or = 18 months) first remission. To adjust for time-to-transplant bias, left-truncated Cox's regression models were constructed. Relapse rates were similar after chemotherapy and transplantation. In both treatment groups, relapse rates were higher in older children (11-17 years; RR 2.81, P=0.002) and shorter first remission (< 18 months; RR 3.89, P<0.001). Treatment-related mortality rates were higher after transplantation (RR 4.28, P=0.001). The 8-year probabilities of leukemia-free survival adjusted for age and duration of first remission were similar after chemotherapy with irradiation and transplantation (66 and 58%, respectively). In the absence of an advantage for one treatment option over another, the data support use of either intensive chemotherapy with irradiation or HLA-matched sibling transplantation with total body irradiation containing conditioning regimen for children with ALL in second remission after an isolated CNS relapse.
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA. meapen@mcw.edu
authors.forename: M
authors.initials: M
authors.lastname: Eapen
authors.forename: M-J
authors.initials: MJ
authors.lastname: Zhang
authors.forename: M
authors.initials: M
authors.lastname: Devidas
authors.forename: E
authors.initials: E
authors.lastname: Raetz
authors.forename: J C
authors.initials: JC
authors.lastname: Barredo
authors.forename: A K
authors.initials: AK
authors.lastname: Ritchey
authors.forename: K
authors.initials: K
authors.lastname: Godder
authors.forename: S
authors.initials: S
authors.lastname: Grupp
authors.forename: V A
authors.initials: VA
authors.lastname: Lewis
authors.forename: K
authors.initials: K
authors.lastname: Malloy
authors.forename: W L
authors.initials: WL
authors.lastname: Carroll
authors.forename: S M
authors.initials: SM
authors.lastname: Davies
authors.forename: B M
authors.initials: BM
authors.lastname: Camitta
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods*; D016543:Central Nervous System Neoplasms / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D018572:Disease-Free Survival; D005260:Female; D006680:HLA Antigens; D006648:Histocompatibility; D006801:Humans; D017254:Leukemic Infiltration / Q000209:etiology / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods; D012008:Recurrence; D012074:Remission Induction; D035781:Siblings; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D006680:HLA Antigens