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Allogeneic bone marrow transplantation versus chemotherapy in children with acute leukemia in Sweden
O Ringdén1, P Bolme, B Lönnqvist
1Department of Clinical Immunology, Huddinge Hospital, Sweden.
Insights
Bone marrow transplantation (BMT) significantly improves survival for children with acute myeloid leukemia. For acute lymphoblastic leukemia (ALL), BMT offers a survival advantage in certain relapse scenarios.
Area of Science:
- Pediatric Oncology
- Hematology
- Transplantation Immunology
Background:
- Bone marrow transplantation (BMT) is a potential curative treatment for pediatric cancers.
- Chemotherapy remains a standard treatment, but relapse necessitates alternative strategies.
Purpose of the Study:
- To compare the survival outcomes of pediatric patients undergoing BMT versus chemotherapy.
- To evaluate the efficacy of BMT in different leukemia subtypes and relapse settings.
Main Methods:
- Retrospective cohort study comparing children treated with BMT versus chemotherapy.
- Patients diagnosed with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) in Sweden were analyzed.
- Survival data was collected for at least 2 years post-diagnosis or relapse.
Main Results:
- In first remission AML, all 11 children receiving BMT survived, versus 1 of 15 on chemotherapy (p < 0.001).
- For ALL relapsing during chemotherapy, 5-year survival was 43% with BMT versus 16% with chemotherapy (p < 0.05).
- For ALL relapsing after therapy cessation, 4-year survival was 33% with BMT versus 55% with chemotherapy (p = 0.05).
Conclusions:
- BMT demonstrates superior survival for pediatric AML in first remission.
- BMT offers a significant survival benefit for relapsed ALL when treated in second to fourth remission.
- The role of BMT in ALL relapsing after therapy cessation requires further investigation due to conflicting results.
Abstract:
All children in Sweden who underwent bone marrow transplantation (BMT) with an HLA-identical sibling during a 5-year period were compared to those who were treated with chemotherapy and survived at least 3 months after remission. All patients were observed for more than 2 years after diagnosis or relapse. All 11 children with acute myeloid leukemia in first remission who underwent BMT survived compared to only 1 of 15 treated with chemotherapy (p less than 0.001). In children with acute lymphoblastic leukemia (ALL), those relapsing while on chemotherapy and treated with BMT in second to fourth remission (n = 16) had a 5-year survival of 43% compared to 16% for those treated with chemotherapy (n = 53, p less than 0.05). In children with ALL relapsing after cessation of therapy, 4-year survival was 33% for BMT (n = 6) and 55% for chemotherapy (n = 15), p = 0.05).