Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Allogeneic hematopoietic cell transplantation (allo-HCT) outcomes for children with B-precursor ALL and early or late BM relapse

Bone Marrow Transplantation volume 46, pages 1571–1572 (2011)Cite this article

Subjects

We thank Professor Ka Leung Cheuk for his interest in our article and for the opportunity to further discuss some controversial aspects of the management of relapsed pediatric ALL, including the use of allogeneic hematopoietic cell transplantation (allo-HCT).

Concern was raised by Professor Ka Leung Cheuk over our recommendation that allo-HCT be pursued after 1st marrow relapse (in CR2), rather than awaiting subsequent treatment failure. This concern arises from the fact that our analysis is based purely on comparing HCT outcomes between CR2 and CR3 patients and the potential biases associated with this type of analysis. Our suggestion that allo-HCT be considered in CR2 for both early and late marrow relapse B-ALL is not merely based on how poorly patients do when brought to HCT in CR3, but more importantly, is based on the seemingly inferior outcomes with intensive chemotherapy re-treatment without transplantation.1, 2, 3 For instance, in our analysis, patients with an early marrow relapse treated with allo-HCT had a 5-year overall survival (OS) of 53%.4 These results compare favorably to what has been described historically for patients receiving chemotherapy alone (5-year OS <30%).1, 2, 3 Importantly, these results are consistent with other retrospective-comparison studies reporting superior outcomes for allo-HCT compared with chemotherapy in B-ALL patients with an early marrow relapse.1, 2, 3 For the late marrow relapse patients transplanted in CR2, we report a 5-yr OS of 75%. These results appear to be superior to the expected survival rates of <45% when chemotherapy alone is given.1, 2, 3, 5 Professor Ka Leung Cheuk comments that our recommendation to transplant all relapsed ALL patients in CR2 can only be directly proven using prospective randomized studies. We completely agree with this. In this regard, the Children's Oncology Group is currently randomizing late-relapsed B-ALL patients in CR2 to either chemotherapy or allo-HCT. Importantly, this study will only use matched related donors and, thus limit any conclusions regarding unrelated donors in this setting. As there have been no prospective clinical trials randomizing children with 2nd relapse (CR3) ALL to chemotherapy versus allo-HCT this also remains unresolved. However, in the meantime, studies such as ours may assist individuals in these difficult treatment decisions involving the utility of allo-HCT in the management of relapsed ALL.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Barrett AJ, Horowitz MM, Pollock BH, Zhang MJ, Bortin MM, Buchanan GR et al. Bone marrow transplants from HLA-identical siblings as compared with chemotherapy for children with acute lymphoblastic leukemia in a second remission. N Engl J Med 1994; 331: 1253–1258.

    Article  CAS  PubMed  Google Scholar 

  2. Bleakley M, Shaw PJ, Nielsen JM . Allogeneic bone marrow transplantation for childhood relapsed acute lymphoblastic leukemia: comparison of outcome in patients with and without a matched family donor. Bone Marrow Transplant 2002; 30: 1–7.

    Article  CAS  PubMed  Google Scholar 

  3. Henze G, Fengler R, Hartmann R, Kornhuber B, Janka-Schaub G, Niethammer D et al. Six-year experience with a comprehensive approach to the treatment of recurrent childhood acute lymphoblastic leukemia (ALL-REZ BFM 85). A relapse study of the BFM group. Blood 1991; 78: 1166–1172.

    CAS  PubMed  Google Scholar 

  4. Beck JC, Cao Q, Trotz B, Smth AR, Weigel BJ, Nerneris MR et al. Allogeneic hematopoietic cell transplantation outcomes for children with B-precursor acute lymphoblastic leukemia and early or late BM relapse. Bone Marrow Transplant 2011; 46: 950–955.

    Article  CAS  PubMed  Google Scholar 

  5. Boulad F, Steinherz P, Reyes B, Heller G, Gillio AP, Small TN et al. Allogeneic bone marrow transplantation versus chemotherapy for the treatment of childhood acute lymphoblastic leukemia in second remission: a single-institution study. J Clin Oncol 1999; 17: 197–207.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Hematology-Oncology-Blood and Marrow Transplantation, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN, USA

    M J Burke & M R Verneris

  2. Division of Pediatric Hematology-Oncology, Children's Hospital and Medical Center of Omaha, Omaha, NE, USA

    J C Beck

Authors
  1. M J Burke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M R Verneris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J C Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M J Burke.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burke, M., Verneris, M. & Beck, J. Allogeneic hematopoietic cell transplantation (allo-HCT) outcomes for children with B-precursor ALL and early or late BM relapse. Bone Marrow Transplant 46, 1571–1572 (2011). https://doi.org/10.1038/bmt.2010.334

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2010.334

Search

Advanced search

Quick links