[Allogeneic bone marrow transplantation in children with acute lymphoblastic leukemia]

Long disease-free survival can be achieved with chemotherapy in over 50% of children with acute lymphoblastic leukaemia (ALL). However, those children suffering relapse or presenting with poor-risk features at diagnosis have scarce possibility of doing well with conventional chemotherapy. Bone marrow transplantation (BMT) is a good choice in such cases.

Between July 1985 and January 1992, twenty-four children with ALL underwent BMT in the Service of Pediatrics of the Hospital Ramón y Cajal. In seven patient with poor-risk criteria at diagnosis BMT was performed in the first complete remission (CR) and in seventeen cases it was performed after the second CR. The conditioning for transplantation consisted of cyclophosphamide plus total body irradiation in 21 patients and cyclophosphamide plus busulphan in 3 others.

Fifteen patients persist in CR with post-transplant follow-up of 3 to 73 months (median, 31 months). Five patients died due to complications of the transplantation techniques, and four others died upon leukaemic relapse. The probability of disease-free survival for all cases is 61%, a plateau being reached at 13 months (83% and 52% for BMT in first or second CR, respectively).

These findings confirm the efficacy of BMT in the treatment of children with ALL in second CR, or in first CR when there are very poor risk criteria at diagnosis.