1. ¹UO Ematologia ed Oncologia Pediatrica, Istituto G Gaslini, Genova, Italy
2. ²Sezione di Statistica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Italy
3. ³Dipartimento Scienze Pediatriche e Adolescentologia, Ospedale Regina Margherita Università di Torino, Italy
4. ⁴Clinica Pediatrica, Università di Milano Bicocca, Ospedale S Gerardo Monza, Italy
5. ⁵Dipartimento Biotecnologie Cellulari ed Ematologia, Università La Sapienza Roma, Italy
6. ⁶Clinica Oncoematologica Pediatrica, Dipartimento di Pediatria, Università di Padova, Italy
7. ⁷Dipartimento Scienze Pediatriche Mediche e Chirurgiche, Ospedale S Orsola Malpighi, Bologna, Italy
8. ⁸Clinica Pediatrica, Università di Trieste, Italy
9. ⁹Clinica Pediatrica, Università di Brescia, Italy
10. ¹⁰Unità di Terapia Intensiva Ematologica per il Trapianto Emopoietico, Ospedale Civile di Pescara, Italy
11. ¹¹Italian Bone Marrow Donor Registry, Italy
12. ¹²Oncoematologia Pediatrica, IRCCS Policlinico S Matteo, Università di Pavia, Italy
13. ¹³Divisione Ematologia II, Ospedale Civile Genova, Italy
14. ¹⁴Clinica Pediatrica, Ospedale S Chiara Università di Pisa, Italy
15. ¹⁵Cattedra di Ematologia, Università di Firenze, Italy

Correspondence: Dr G Dini, Department of Pediatric Haematology and Oncology, G Gaslini Children's Research Hospital, Largo G Gaslini 5, Genova, Italy

¹⁶Current address: UOA Ematologia, Ospedale San Giovanni Battista, Torino, Italy

Received 23 December 2002; Accepted 20 February 2003.

Abstract

We analyzed the outcome of 167 consecutive children with second CR acute lymphoblastic leukemia (ALL), for whom an unrelated donor (UD) search was activated between 1989 and 1998 at a median time of 2 months after relapse. A suitable donor was identified for 70 patients at 1 year and 6.5 months before and after 1995 from search activation, respectively; a further leukemia relapse occurred during the search in 94 children at a median of 4 months after search activation, 36 of whom underwent UD (14) or other types of transplant (22), beyond second CR, while 58 died of progressive disease. Of 73 patients not experiencing a second relapse, 64 underwent UD (46) or other types of transplant (18), while nine proceeded with chemotherapy, and only four of them survived. The 3-year disease-free survival (DFS) from second CR for the 167 patients is 15.1%, whereas 3-year DFS after transplant for the 60 UD and 40 alternative donor transplanted children is 31.6 and 25.4%, respectively. In conclusion, a further relapse is the main factor adversely affecting outcome of children with second CR ALL. Thus, for these patients, the search should be activated early after relapse and either a UD or an alternative transplant should be performed as early as possible.