Journal of Clinical Oncology, Vol 15, 2238-2246, Copyright © 1997 by American Society of Clinical Oncology
Late effects of allogeneic bone marrow transplantation for children with acute myeloblastic leukemia in first complete remission: the impact of conditioning regimen without total-body irradiation--a report from the Societe Francaise de Greffe de Moelle
G Michel, G Socie, F Gebhard, F Bernaudin, I Thuret, JP Vannier, F Demeocq, G Leverger, JL Pico, H Rubie, F Mechinaud, J Reiffers, N Gratecos, X Troussard, JP Jouet, G Simonin, E Gluckman and D Maraninchi
Hopital d'Enfants La Timone and the Institut Paoli-Calmettes, Marseille, France. gmichel@ap_hm.fr
PURPOSE: To evaluate growth, thyroid function, puberty, cardiac function,
and the incidence of cataracts in children who received allogeneic bone
marrow transplantation (BMT) for acute myeloblastic leukemia (AML) in first
complete remission (CR) after a preparation with or without total-body
irradiation (TBI). PATIENTS AND METHODS: Among 45 children studied, 26
received busulfan-cyclophosphamide (Bu- Cy) in preparation for
transplantation and 19 received TBI. TBI was fractionated in nine cases and
delivered as a single dose in 10. Four children in the Bu-Cy group and none
in the TBI group had received prior cranial radiation. The mean follow-up
duration after BMT was 5.9 years for the whole group. RESULTS: The mean
cumulative changes in height SD score (SDS) were -0.86 at 3 years and -1.56
at 5 years in the TBI group, whereas these changes were only -0.05 and
-0.17 in the Bu-Cy group (P < .01 at 3 and 5 years). The 6-year
probability of hypothyroidism was 9% +/- 8% in the Bu-Cy group and 43% +/-
15% after TBI (P < .02). Pubertal development after Bu-Cy was assessable
in two girls and five boys: both girls had primary ovarian failure, whereas
Leydig cell function appeared to be preserved in the five boys. One child
who had received anthracycline when he was less than 1 year old developed
cardiac dysfunction 4 years after Bu-Cy. The 6-year probability of
cataracts was 70% +/- 13% in the TBI group and 0% after Bu-Cy. CONCLUSION:
The use of Bu-Cy represents an alternative transplant cytoreductive regimen
for children with AML in first CR, which can reduce the risk of
posttransplant growth impairment, thyroid dysfunction, Leydig cell damage,
and the incidence of cataracts.
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