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Autologous bone marrow transplantation for childhood acute lymphoblastic leukemia in remission: first choice for
P Colleselli1, F Rossetti, C Messina
1Centro Leucemie Infantili, Università di Padova, Italy.
Insights
Autologous bone marrow transplant (BMT) for pediatric ALL relapse showed poor outcomes after marrow relapse. However, BMT following isolated extramedullary relapse offered a favorable 5-year survival, suggesting its potential benefit for select patients.
Area of Science:
- Pediatric Hematology/Oncology
- Stem Cell Transplantation
Background:
- Autologous bone marrow transplant (BMT) is a treatment for pediatric acute lymphoblastic leukemia (ALL).
- Relapse remains a significant challenge in ALL treatment, necessitating effective salvage strategies.
Purpose of the Study:
- To evaluate the efficacy of autologous BMT in children with relapsed ALL.
- To identify prognostic factors influencing outcomes after autologous BMT in this population.
Main Methods:
- Retrospective analysis of clinical data from 75 children with ALL who underwent autologous BMT between 1984 and 1992.
- Data collected from the Italian Association of Pediatric Hemato/Oncology (AIEOP) BMT Registry.
- Analysis of relapse patterns (marrow vs. isolated extramedullary) and transplant-related complications.
Main Results:
- Overall 5-year disease-free survival (DFS) was 27.8%.
- Isolated extramedullary relapse was the sole factor significantly impacting DFS.
- Autologous BMT after marrow relapse yielded a poor 5-year DFS (13%), while BMT after isolated extramedullary relapse showed a favorable DFS (nearly 70%).
- Nine percent of patients experienced transplant-related mortality.
Conclusions:
- Autologous BMT offers limited benefit for pediatric ALL patients relapsing after marrow involvement.
- Autologous BMT demonstrates significant potential for patients with early, isolated extramedullary relapse.
- Patient selection based on relapse pattern is crucial for optimizing autologous BMT outcomes in ALL.
Abstract:
Between May 1984 and May 1992, 75 children 3-19 (median 9) years of age underwent autologous marrow transplant. Clinical data were obtained from the BMT Registry of the AIEOP (Italian Association of Pediatric Hemato/Oncology). Fifty-six children were transplanted after marrow +/- other site(s) relapse and 19 after an isolated extramedullary relapse. The transplant preparative regimens varied according to the center performing the transplant. Seven patients (9%) died of transplant-related complications. Forty-four (58.6%) of 75 patients relapsed again following autologous BMT. The 5-year DFS was 27.8%. An isolated extramedullary relapse was the only variable that statistically influenced DFS. In this retrospective study, autologous BMT for patients with ALL in second CR following marrow relapse did not offer an encouraging result (13% probability of DFS at 5 years), whereas autologous BMT following an (early) isolated extramedullary relapse resulted in nearly 70% DFS. Autologous BMT may be appropriate for this latter group of patients.