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Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research. Blood 2006 Jun 15;107(12):4961-7

Date

02/24/2006

Pubmed ID

16493003

Pubmed Central ID

PMC1895819

DOI

10.1182/blood-2005-12-4942

Scopus ID

2-s2.0-33745080964   108 Citations

Abstract

The best treatment approach for children with B-precursor acute lymphoblastic leukemia (ALL) in second clinical remission (CR) after a marrow relapse is controversial. To address this question, we compared outcomes in 188 patients enrolled in chemotherapy trials and 186 HLA-matched sibling transplants, treated between 1991 and 1997. Groups were similar except that chemotherapy recipients were younger (median age, 5 versus 8 years) and less likely to have combined marrow and extramedullary relapse (19% versus 30%). To adjust for time-to-transplant bias, treatment outcomes were compared using left-truncated Cox regression models. The relative efficacy of chemotherapy and transplantation depended on time from diagnosis to first relapse and the transplant conditioning regimen used. For children with early first relapse (< 36 months), risk of a second relapse was significantly lower after total body irradiation (TBI)-containing transplant regimens (relative risk [RR], 0.49; 95% confidence interval [CI] 0.33-0.71, P < .001) than chemotherapy regimens. In contrast, for children with a late first relapse (> or = 36 months), risks of second relapse were similar after TBI-containing regimens and chemotherapy (RR, 0.92; 95% CI, 0.49-1.70, P = .78). These data support HLA-matched sibling donor transplantation using a TBI-containing regimen in second CR for children with ALL and early relapse.

Author List

Eapen M, Raetz E, Zhang MJ, Muehlenbein C, Devidas M, Abshire T, Billett A, Homans A, Camitta B, Carroll WL, Davies SM, Children's Oncology Group, Center for International Blood and Marrow Transplant Research

Authors

Bruce M. Camitta MD Clinical Professor in the Medicine department at Medical College of Wisconsin
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Bone Marrow
Burkitt Lymphoma
Child
Child, Preschool
Clinical Trials as Topic
Female
Histocompatibility Testing
Hospitals
Humans
Infant
Living Donors
Male
Recurrence
Remission Induction
Retrospective Studies
Siblings
Stem Cell Transplantation
Transplantation, Homologous
Treatment Outcome
jenkins-FCD Prod-409 d1e206b0be345926047b0d9c353c78a4cce4058b