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Pediatric Transplants

Alternative donor bone marrow transplant for children with Philadelphia chromosome ALL

Bone Marrow Transplantation volume 37, pages 135–141 (2006)Cite this article

Abstract

Children with Philadelphia chromosome positive (Ph+) acute lymphocytic leukemia (ALL) have only a 20% event-free survival when treated with chemotherapy alone. Bone marrow transplant (BMT) for patients with matched siblings has been associated with significantly better long-term survival. We asked whether children who lack a matched sibling donor would do as well if an alternative donor was utilized. Between 1987 and 2002, we transplanted 29 children and adolescents using either an unrelated donor (23) or a mismatched family member (six). The conditioning regimen included cytosine-arabinoside, cyclophosphamide and total body irradiation. Graft-versus-host disease (GVHD) prophylaxis consisted of T-cell depletion (antibody T10B9 or OKT3 and complement) with post transplant cyclosporine (CSA). All patients engrafted. Four developed grades III–IV acute GVHD. Three of 24 evaluable patients developed extensive chronic GVHD. Two patients died of relapse (7%). Two long-term survivors (>6 years) died of malignant glioblastoma multiforme. Event-free survival at 3, 5, and 10 years is 56, 51, and 46%, respectively. Five of six patients in >CR2 or relapse at the time of transplant died. Our data should encourage the use of alternative donor transplants early in the course of disease for children with Ph+ ALL.

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Acknowledgements

We thank Dan Eastwood, MS and Christian Boudreau, Ph.D., for their statistical assistance with this manuscript. This study was supported in part by the Midwest Athletes Against Childhood Cancer (MACC Fund).

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Authors and Affiliations

  1. Department of Pediatric Hematology, Oncology, Bone Marrow Transplant, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA

    J M Talano, J T Casper, B M Camitta, M Eapen & D A Margolis

  2. Department of Bone Marrow Transplantation, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA

    C A Keever-Taylor

  3. Department of Radiation Oncology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA

    K J Murray

  4. Histocompatibility Laboratory, The Blood Center of Southeastern Wisconsin, Milwaukee, WI, USA

    K L Pierce

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  1. J M Talano
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  2. J T Casper
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Correspondence to J M Talano.

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Talano, J., Casper, J., Camitta, B. et al. Alternative donor bone marrow transplant for children with Philadelphia chromosome ALL. Bone Marrow Transplant 37, 135–141 (2006). https://doi.org/10.1038/sj.bmt.1705200

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