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[Bone marrow transplant in acute leukemia in children. Experience of the Pesaro group]
C Giardini1, P Polchi, G Lucarelli
1Divisione Ematologica e Centro Trapianto di Midollo Osseo di Muraglia--Ospedale di Pesaro.
Insights
Busulphan and Cyclophosphamide chemotherapy alone improved survival and reduced relapse rates in children with leukemia compared to cyclophosphamide and Total Body Irradiation. This chemotherapy-only regimen also lowered the incidence of Interstitial Pneumonia.
Area of Science:
- Pediatric Hematology Oncology
- Stem Cell Transplantation
Background:
- Acute lymphoblastic leukemia (ALL) and acute nonlymphoblastic leukemia (ANLL) are significant pediatric cancers.
- Hematopoietic stem cell transplantation (HSCT) is a curative option for pediatric leukemia.
- Preparative regimens are crucial for HSCT success, aiming to eradicate leukemia while minimizing toxicity.
Purpose of the Study:
- To compare the efficacy and toxicity of two different preparative regimens in pediatric patients undergoing HSCT for leukemia.
- To evaluate survival rates, relapse rates, and the incidence of Interstitial Pneumonia between the two regimens.
Main Methods:
- A cohort of 30 children (aged 1-15 years) with ALL or ANLL received HSCT from HLA-matched donors.
- Patients were divided into two groups based on preparative regimens: cyclophosphamide and Total Body Irradiation (TBI) (n=18), or Busulphan and Cyclophosphamide (BuCy) (n=12).
- Outcomes including survival, relapse, and Interstitial Pneumonia incidence were assessed.
Main Results:
- Overall survival was higher in the BuCy group (71%) compared to the cyclophosphamide/TBI group (28%).
- The relapse rate was lower in the BuCy group (30%) versus the cyclophosphamide/TBI group (56%).
- The incidence of Interstitial Pneumonia was lower in patients who received the BuCy regimen.
Conclusions:
- The combination chemotherapy regimen of Busulphan and Cyclophosphamide appears to be a well-tolerated and effective preparative regimen for pediatric leukemia HSCT.
- This regimen demonstrates improved survival and reduced relapse rates compared to cyclophosphamide and TBI.
- Further follow-up is necessary to fully evaluate long-term disease eradication and toxicity of the BuCy regimen.
Abstract:
Thirty children aged one to 15 years with acute lymphoblastic leukemia and acute nonlymphoblastic leukemia were transplanted from HLA matched donors using two different preparative regimens: 18 patients were prepared with cyclophosphamide and Total Body Irradiation while 12 patients received Busulphan and Cyclophosphamide. 15 patients survive 7 to 74 months after transplant. Although for the second group of patients a longer follow-up is needed in order to evaluate eradication of the disease and long-term toxicity, the combination chemotherapy alone results in improving survival (71% versus 28%) and decreasing relapse rate (30% versus 56%) compared with the group of patients who received the chemoradiotherapy regimen. Also the incidence of Interstitial Pneumonia has been lower in the group receiving chemotherapy alone. We conclude that this protocol is generally well tolerated in young patients, without increasing secondary toxicity.