Journal of Clinical Oncology, Vol 8, 295-303, Copyright © 1990 by American Society of Clinical Oncology
Allogeneic bone marrow transplantation in a program of intensive sequential chemotherapy for children and young adults with acute nonlymphocytic leukemia in first remission
GV Dahl, DK Kalwinsky, J Mirro Jr, AT Look, CH Pui, SB Murphy, C Mason, M Ruggiero, M Schell and FL Johnson
Division of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN.
Eighty-seven consecutive children and young adults with acute
nonlymphocytic leukemia (ANLL) were treated uniformly with induction
chemotherapy based on daunorubicin and cytarabine (ara-C), with the
addition of etoposide (VP-16) and azacytidine (5-Az) for refractory
patients. Of the 65 patients who entered complete remission, 42 were
eligible for assessment of response to intensive chemotherapy consisting of
four pairs of drugs administered in sequential fashion. Nineteen others
with available histocompatibility locus antigen (HLA)- compatible donors
were assigned to receive allogeneic bone marrow transplants within 16 weeks
from their dates of complete remission. Durations of continuous complete
remission (CCR) in the two groups were not significantly different at a
median follow-up time of 6 years (P = .30 by log-rank analysis).
Kaplan-Meier estimates of CCR probabilities (+/- SE) at 6 years were 43%
+/- 13% (transplantation) and 31% +/- 7% (sequential chemotherapy).
Postremission failures in the sequential chemotherapy group resulted from
bone marrow relapse in 23 of 29 patients (79%), whereas in the
transplantation group, failures were equally divided between marrow relapse
and transplantation-related complications of graft-versus-host disease
(GVHD) or infection due to the immunosuppressive effects of ablative
chemotherapy. Comparison of hematologic remission curves indicated a
significant advantage for marrow transplantation in terms of systemic
leukemia control (P = .06). Thus, in programs of intensive chemotherapy of
the type described here, allogeneic marrow transplantation should be
seriously considered as alternative therapy for patients in first remission
who have an HLA- matched sibling donor, provided that effective methods for
control of transplant-related complications are available.
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