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Acute Lymphoblastic Leukemia

Allogeneic bone marrow transplantation vs chemotherapy for children with Philadelphia chromosome-positive acute lymphoblastic leukemia

Bone Marrow Transplantation volume 33, pages 39–45 (2004)Cite this article

Summary:

Allogeneic bone marrow transplant (BMT) with an MRD in complete remission (CR)1 is the preferred treatment for children with Philadelphia-positive (Ph+) ALL. The role of MUD BMT in CR1 is still controversial. We compared the outcomes of two treatment strategies: BMT using an MRD or MUD vs chemotherapy in children with Ph+ ALL in CR1. In total, 21 children were treated from 1985 to 2001. In all, 10 received chemotherapy and 11 received allogeneic BMT: four MRD, seven MUD. In the MRD group, one relapsed 12 months after BMT and died; the remaining three are long-term event-free survivors (median follow-up, 6.1 years). In the MUD group four died; the remaining three are long-term event-free survivors (median follow-up, 7.2 years). The 4-year event-free survival (EFS) for the BMT group was 53±15%. In the chemotherapy group, seven relapsed after a median period of 12.5 months and three remain in continuous CR (median follow-up, 2.4 years). Four chemotherapy patients received CR2 transplants; all died. The 4-year EFS for the chemotherapy and MUD groups was 33±17 and 35.7±20%, respectively. This difference was not statistically significant. We continue to support treating children with Ph+ ALL with MRD BMT in CR1. The effectiveness of MUD BMT vs chemotherapy merits further study.

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Acknowledgements

We thank Chris Armstrong RN NP, Kim Yuille RN, Martha Rolland, the staff of the BMT unit, patients and their families, as well as physicians and staff at other Canadian centers who participated in the care of these children – Dr J Hand, Janeway Child Health Centre, St John's, Newfoundland; Dr C Fernandez, IWK Grace Health Centre, Halifax, Nova Scotia; Dr R Klaassen, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Dr M Silva, Kingston General Hospital, Kingston, Ontario; Dr E Cairney, Children's Hospital of Western Ontario, London, Ontario; Dr R Barr, Dr M Pai, McMaster University Medical Centre, Hamilton, Ontario. We also acknowledge Dr Lillian Sung for helpful discussions and advice, Mr Derek Stephens for statistical assistance and the Editorial Services of The Hospital for Sick Children, Toronto, Canada for the technical assistance.

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  1. Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada

    A Sharathkumar, E F Saunders, Y Dror, R Grant, M Greenberg, S Weitzman, H Chan, M H Freedman & J Doyle

  2. Division of Bone Marrow Transplantation, City of Hope Medical Center, Duarte, CA, USA

    S Calderwood

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  1. A Sharathkumar
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Correspondence to J Doyle.

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Sharathkumar, A., Saunders, E., Dror, Y. et al. Allogeneic bone marrow transplantation vs chemotherapy for children with Philadelphia chromosome-positive acute lymphoblastic leukemia. Bone Marrow Transplant 33, 39–45 (2004). https://doi.org/10.1038/sj.bmt.1704319

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