Allogeneic bone marrow transplant in pediatric patients with high-risk hematopoietic malignancies early in the course of their disease.

Abstract

PURPOSE:

The purpose of this study was to investigate the role of bone marrow transplant (BMT) early in the course of disease for pediatric patients with high-risk leukemia using a preparatory regimen of fractionated total body irradiation (FTBI) and etoposide (VP-16).

PATIENTS AND METHODS:

Those studied were 33 patients aged < or =18 years with either acute leukemia in first complete remission (CR) (n = 29) or chronic myelogenous leukemia (CML) in first chronic phase (n = 4) who received 1,320 cGy FTBI followed by high-dose VP-16 (60 mg/kg) as a preparatory regimen for BMT from matched sibling donors. Patients with acute leukemia included 18 with acute nonlymphocytic leukemia (ANLL), one with biphenotypic acute leukemia (BAL), and 10 with selected "high-risk" acute lymphocytic leukemia (ALL). Patients with ALL were selected for a high risk for recurrence: those who failed standard remission induction chemotherapy, had a t(9;22) or t(4;11) chromosomal translocation, or had certain clinical high-risk features.

RESULTS:

At the time of analysis, 28 patients are alive, all of them in continued complete remission for 1.1-7.8 years (median, 5.3 years; mean, 4.9 years). The Kaplan-Meier projected event-free survival (EFS) is 84.5% at 7 years, and the actuarial recurrence hazard is 6.5%. All surviving patients have a performance status of >80%.

CONCLUSION:

This result of early BMT in a two-institution study of pediatric patients with hematopoietic malignancies suggests that (a) matched sibling allogeneic BMT after conditioning with FTBI and high-dose VP-16 is an excellent treatment for pediatric patients with high-risk leukemia, and (b) children may have a better prognosis than adults treated with allogeneic BMT. Larger multiinstitutional cooperative trials for pediatric patients are needed to confirm this result.

• Authors: M D Amylon, J P Co, D S Snyder, S S Donaldson, K G Blume, S J Forman
• Journal: Journal of pediatric hematology/oncology (J Pediatr Hematol Oncol) 1997 Jan-Feb Vol. 19 Issue 1 Pg. 54-61 ISSN: 1077-4114 [Print] United States
• PMID: 9065720 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antineoplastic Agents, Phytogenic
• Etoposide

Topics

• Adolescent
• Adult
• Antineoplastic Agents, Phytogenic (therapeutic use)
• Bone Marrow Transplantation
• Child
• Child, Preschool
• Combined Modality Therapy
• Etoposide (therapeutic use)
• Female
• Hematologic Neoplasms (physiopathology, therapy)
• Humans
• Infant
• Male
• Time Factors
• Transplantation, Homologous
• Treatment Outcome