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Bone marrow transplantation for children with acute myelogenous leukaemia in the first complete remission
T Matsuyama1, K Horibe, K Kato
1Division of Haematology/Oncology, Children's Medical Center, Japanese Red Cross, Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya City, Japan. matsujii@nagoya-1st.jrc.or.jp
Insights
Bone marrow transplantation (BMT) is effective for childhood acute myelogenous leukaemia (AML) in first complete remission. Both allogeneic (allo-BMT) and autologous (ABMT) transplants show high long-term disease-free survival rates.
Area of Science:
- Hematology
- Pediatric Oncology
- Transplantation Immunology
Background:
- Acute myelogenous leukaemia (AML) is a significant challenge in pediatric oncology.
- Bone marrow transplantation (BMT) is a potential curative option for children with AML in first complete remission.
- Comparing allogeneic (allo-BMT) and autologous (ABMT) BMT outcomes is crucial for treatment optimization.
Purpose of the Study:
- To evaluate the efficacy and outcomes of BMT in children with AML in first complete remission.
- To compare the disease-free survival rates between allo-BMT and ABMT.
- To assess the incidence of graft-versus-host disease (GVHD) and transplant-related mortality.
Main Methods:
- Retrospective analysis of 52 children (9 months to 16 years) with AML undergoing BMT.
- Patients received either allo-BMT (n=31) or ABMT (n=21).
- Conditioning regimens included chemotherapy or total body irradiation plus chemotherapy; GVHD prophylaxis used methotrexate +/- cyclosporin A for allo-BMT.
Main Results:
- Overall 5-year disease-free survival was 83% (84% for allo-BMT, 81% for ABMT).
- GVHD occurred in 23% of allo-BMT recipients; 15% of all patients died (including transplant-related mortality).
- Relapse rates were 23% (3 allo-BMT, 4 ABMT).
Conclusions:
- BMT is an effective treatment for eradicating childhood AML in first complete remission.
- Both allo-BMT and ABMT demonstrate comparable long-term disease-free survival.
- Careful management of GVHD and transplant-related complications is essential for successful outcomes.
Abstract:
Of 52 children aged 9 months to 16 years old with acute myelogenous leukaemia (AML) in first complete remission undergoing bone marrow transplantation at our institution, 31 received allogeneic transplants (allo-BMT) and 21 received autologous transplants (ABMT). Initial induction and consolidation chemotherapy were not uniform. BMT was performed at a median of 7 months (range: 2.5 to 22.5 months) from the diagnosis. Conditioning included chemotherapy (n=43: 4 x 4 mg/kg of busulfan and 3 x 60 to 70 mg/m(2) of melphalan) or total body irradiation (12 Gy) plus chemotherapy (n=9). Graft-versus-host disease (GVHD) prophylaxis in allo-BMT cases consisted of methotrexate +/- cyclosporin A. Unpurged marrow was used in ABMT cases. All patients showed sustained engraftment. Amongst allograft cases, acute or chronic GVHD developed in 7 patients each (23%). 8 patients (15%) died (5 with allo-BMT, 3 with ABMT), including transplant-related mortality in 3 of the allo-BMT patients. 7 patients had relapses (3 with allo-BMT, 4 with ABMT). As of June 1999, 43 patients are alive and well 13 to 160 months after BMT (median, 71), with 5-year disease-free survival rates after BMT of 84% for allo-BMT, 81% for ABMT and 83% altogether. Although the presented data are based on a retrospective evaluation, we consider BMT for childhood AML during first complete remission an effective treatment for eradicating leukaemia.