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Bone marrow transplantation improves survival for acute lymphoblastic leukemia in relapse: a preliminary report
P A de Alarcon1, M E Trigg, R H Giller
1Department of Pediatrics and Radiology, University of Iowa, Iowa City 52242.
Insights
This study explores intensive bone marrow transplant preparative regimens for refractory childhood acute lymphoblastic leukemia (ALL). Early results show promising survival rates, suggesting improved outcomes for patients with relapsed or refractory ALL.
Area of Science:
- Pediatric Hematology/Oncology
- Cancer Biology
- Stem Cell Transplantation
Background:
- Childhood acute lymphoblastic leukemia (ALL) is a common pediatric malignancy.
- While chemotherapy achieves high remission rates (>95%), 30% of patients relapse.
- Refractory leukemia, where remission is not achieved or relapse is rapid, presents a significant challenge, affecting 10-40% of patients.
Purpose of the Study:
- To evaluate the early results of an intensive preparative regimen for bone marrow transplantation in pediatric patients with refractory acute lymphoblastic leukemia.
- To assess the survival outcomes and leukemia-free status in this patient cohort.
Main Methods:
- A cohort of twenty-three pediatric patients with refractory leukemia underwent bone marrow transplantation.
- The preparative regimen included etoposide, cytosine arabinoside, cyclophosphamide, and fractionated total body irradiation.
- Survival was projected at 917 days post-transplantation.
Main Results:
- Projected survival at 917 days was 43.4% +/- 11%.
- Survival outcomes were comparable to those of children with ALL transplanted in second remission.
- All patients transplanted in relapse were leukemia-free 27 days post-transplantation.
Conclusions:
- An intensive preparative regimen for bone marrow transplantation shows potential for improving outcomes in refractory childhood ALL.
- This regimen may offer a rescue option for patients with refractory disease who would otherwise have a poor prognosis.
Abstract:
Acute lymphoblastic leukemia of childhood is the most common malignant disease in children greater than 1 year of age. Chemotherapy has improved the survival of children with this disorder. More than 95% of children will achieve a remission with chemotherapy. However, 30% of children with acute lymphoblastic leukemia who achieved a remission will have a relapse sometime after successful remission-inducing chemotherapy. Although a second remission can be induced in most of these children, in 10-40% a remission cannot be induced or they relapse shortly thereafter and develop refractory leukemia. We present in this preliminary report the early results of therapy for refractory leukemia with an intensive preparative regimen for bone marrow transplantation including etoposide, cytosine arabinoside, cyclophosphamide, and fractionated total body irradiation. Transplantation was done in twenty-three patients with refractory leukemia. Projected survival at 917 days after transplantation in these patients is 43.4% +/- 11%. The survival of these patients so far is similar to the survival of children with acute lymphoblastic leukemia transplanted in second remission. All patients treated with this regimen who had transplantation in relapse were free of leukemia 27 days after transplantation. The results of this preliminary report suggest that an intensive preparative regimen can improve the outlook of refractory leukemia and may rescue some patients who otherwise would have died of their disease.