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Pediatric Transplants

HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

Bone Marrow Transplantation volume 40, pages 319–327 (2007)Cite this article

Abstract

To examine relapse, survival and transplant-related complications in relationship to disease- and pre-treatment-related characteristics, we evaluated 132 children, who consecutively received an allogeneic HLA-identical SCT for acute leukaemia in our centre: ALL in first remission (n=24), ALL in second remission (n=53) and AML in first remission (n=55). The source of the stem cells was bone marrow in all but three cases. Most patients (89%) were pre-treated with cyclophosphamide and an age-related dose of TBI. Initially, GVHD prophylaxis consisted of long-course MTX only (n=24), later short-course MTX and CsA (n=102) was given. All patients were nursed in strictly protective isolation and received total gut decontamination to suppress their potentially pathogenic enteric microflora. The 5-year probability of overall survival was 63, 53 and 74% for ALL1, ALL2 and AML1, respectively (median follow-up: 10.6 years). The overall transplant-related mortality was 6%. The incidence of acute GVHD was 17%; 6% was grades II–IV. A higher total biologically effective TBI dose (BED) resulted in a decreased relapse frequency (P=0.034) and increased overall survival. AML patients with acute GVHD got no relapse (P=0.02); this was not the case in ALL patients. Fractionated TBI regimens with higher BED should be evaluated in prospective studies.

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Acknowledgements

We thank the medical, nursing and ancillary staff of the IHOBA unit, and Mrs JDJ Bakker – Steeneveld, data manager, Department of Paediatrics, LUMC, for their care and management of patients undergoing bone marrow transplantation. Mrs M Labopin, data manager of the EBMT-ALWP group, provided the data on children treated for acute leukaemia and registered centrally; the authors are grateful for her help.

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Authors and Affiliations

  1. Division of Immunology, Department of Paediatrics, Hematology, Oncology and Bone Marrow Transplantation and Autoimmune Diseases, Leiden University Medical Centre, Leiden, The Netherlands

    A J Willemze, R M Egeler & J M Vossen

  2. Department of Medical Statistics and Bioinformatics, Leiden University, Leiden, The Netherlands

    R B Geskus

  3. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands

    R B Geskus

  4. Division of Radiation Oncology, Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands

    E M Noordijk

  5. Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands

    H B Kal

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  1. A J Willemze
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Correspondence to A J Willemze.

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Willemze, A., Geskus, R., Noordijk, E. et al. HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI. Bone Marrow Transplant 40, 319–327 (2007). https://doi.org/10.1038/sj.bmt.1705729

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