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Response to the letter by M Koyama et al

Bone Marrow Transplantation volume 36, page 454 (2005)Cite this article

We thank Koyama et al for their comments on our paper1 and on another recently published patient series,2 and for adding their own interesting case. Since the relapse incidence in hematopoietic stem cell transplantation (HSCT) for juvenile myelomonocytic leukemia (JMML) is around 35% in almost every recent series,1 it is important to keep the discussion alive to continue improving the treatment of children with JMML.

First of all, in our series, intensive chemotherapy given to children with JMML before HSCT did not provide better results in terms of event-free survival, relapse incidence, and transplant-related mortality in comparison with less intensive or no chemotherapy at all.2 That was the basis of our conclusion that in terms of toxicity and morbidity it would be better to omit intensive chemotherapy. Similarly, based on the outcome of a large multicenter EWOG-MDS/EBMT trial Locatelli et al concluded with the same arguments that intensive chemotherapy prior to allogeneic HSCT cannot be recommended. In contrast, Koyama et al state without giving an appropriate reference, that consensus clinical opinion recommends the use of intensive AML-like chemotherapy.

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References

  1. Korthof ET, Snijder PP, de Graaff AA et al. Allogeneic bone marrow transplantation for juvenile myelomonocytic leukemia: a single center experience of 23 patients. Bone Marrow Transplant 2005; 35: 455–461.

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  2. Locatelli F, Nollke P, Zecca M et al. Hematopoietic stem cell transplantation (HSCT) in children with juvenile myelomonocytic leukemia (JMML): results of the EWOG-MDS/EBMT trial. Blood 2005; 105: 410–419.

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Authors and Affiliations

  1. Department of Pediatric Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands

    E T Korthof, P P Snijder, A A de Graaff, A C Lankester, R G M Bredius, L M Ball, J W L T Lie, J M Vossen & R M Egeler

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  1. E T Korthof
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  2. P P Snijder
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  3. A A de Graaff
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  4. A C Lankester
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  5. R G M Bredius
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  6. L M Ball
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  7. J W L T Lie
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  8. J M Vossen
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  9. R M Egeler
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Korthof, E., Snijder, P., de Graaff, A. et al. Response to the letter by M Koyama et al. Bone Marrow Transplant 36, 454 (2005). https://doi.org/10.1038/sj.bmt.1705048

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