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Autologous bone marrow transplantation for childhood acute lymphoblastic leukemia in second remission

Bone Marrow Transplantation volume 26, page 1136 (2000)Cite this article

We read with interest the paper by Vaidya and co-workers1 in which they reported their experience with unpurged ABMT for childhood ALL in 31 patients in second remission. Previously, our group published our experience in the treatment of childhood ALL with purged ABMT in 55 patients in second remission.2 The criteria for early and late relapse were the same in both studies and patient age, sex, number of cases with early and late relapse, and interval from relapse to ABMT were comparable. There were differences between both studies in the conditioning regimens. The patients in the Vaidya et al series received single fraction TBI at a median dose of 10.5 Gy, while our patients received fractionated TBI at a median dose of 12 Gy (200 cGy twice daily for 3 days). In the Vaidya series, the patients received chemotherapy with melphalan at a dose of 140 mg/m2 and our patients received cyclophosphamide (120 mg/kg) or cyclophosphamide + Ara-C (18 g/m2) or VP-16 (45–50 mg/m2). The survival rate in both studies was the same (45%). The observation that single-dose TBI does not result in higher survival has been corroborated in a recent prospective randomized study.3

Vaidya et al reported late effects of cataracts that required surgery in 12 of their 15 surviving patients and growth hormone insufficiency in 14 of 15 surviving patients that required growth hormone replacement. Although our late effects were not mentioned in our paper,2 unlike the Vaidya series we had no cases of cataracts in our 26 surviving patients and only two of these 26 patients developed growth hormone insufficiency. Both patients had previously received cranial irradiation as part of their initial treatment before they were referred to our hospital for purged ABMT. Furthermore, with the use of unpurged bone marrow Vaidya et al reported that four of 31 patients did not achieve sustained engraftment (one neutrophil and three platelet). In our series, despite manipulation for marrow purging with monoclonal antibodies plus complement or immunomagnetic microspheres, all 55 of our patients engrafted, which shows that this procedure does not compromise engraftment.

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References

  1. Vaidya SJ, Atra A, Bahl S et al. Autologous bone marrow transplantation for childhood acute lymphoblastic leukemia in second remission – long-term follow-up Bone Marrow Transplant 2000 25: 599–603

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  2. Maldonado MS, Díaz-Heredia C, Badell I et al. Autologous bone marrow transplantation with monoclonal antibody purged marrow for children with acute lymphoblastic leukemia in second remission Bone Marrow Transplant 1998 22: 1043–1047

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  3. Girinsky T, Benhamou E, Bourhis JH et al. Prospective randomized comparison of single-dose versus hyperfractionated total-body irradiation in patients with hematologic malignancies J Clin Oncol 2000 18: 981–986

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  4. Messina C, Cesaro S, Rondelli R . Autologous bone marrow transplantation for childhood acute lymphoblastic leukaemia in Italy Bone Marrow Transplant 1998 21: 1015–1021

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  1. Department of Pediatrics, Ramón y Cajal Hospital, University of Alcalá, Madrid, 28034, Spain

    MS Maldonado & A Muñoz

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  1. MS Maldonado
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  2. A Muñoz
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Maldonado, M., Muñoz, A. Autologous bone marrow transplantation for childhood acute lymphoblastic leukemia in second remission. Bone Marrow Transplant 26, 1136 (2000). https://doi.org/10.1038/sj.bmt.1702686

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