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Allogeneic marrow transplantation in children with acute leukemia: careful comparison with chemotherapy alternatives required

Leukemia volume 24, pages 1212–1216 (2010)Cite this article

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Don Pinkel has a tremendous record of accomplishment in the development of modern therapies for childhood acute lymphoblastic leukemia (ALL). He had a pivotal role in the development and evolution of early ‘Total Therapy’ studies for childhood ALL at St Jude Children's Research Hospital in the 1960s and 1970s. He dared to believe that this, until then, universally fatal disease could be cured and saw his dreams come true. At about the same time, others, most notably Don Thomas, dared to believe that allogeneic hematopoietic stem cell transplantation (HSCT) could cure patients with leukemia. Time has shown that both Don Pinkel and Don Thomas were correct. Today, over 80% of children diagnosed with ALL in North America and Western Europe will be cured, and HSCT has cured thousands of children and adults with leukemia, bone marrow failure states and other disorders.

Given this background, we are troubled by the recent editorial by Dr Pinkel updating his view that the use of allogeneic HSCT to treat children with leukemia is ‘a practice whose time has gone’.1 Although we wish that all children with leukemia could be cured with chemotherapy and therefore have no need for HSCT, this is simply not the case today, and is unlikely to become true in the near future. As specialists in the treatment of childhood leukemia, with or without HSCT, we believe, our job is to carefully weigh the relative advantages and disadvantages of chemotherapy or HSCT approaches in different clinical settings, develop rational treatment algorithms and design clinical trials to answer critical questions. We believe that the editorial by Dr Pinkel fails to put these different treatment modalities in the proper perspective and are particularly concerned that his portrayal of HSCT as curing children at the cost of universal, significant late effects, while late effects of chemotherapy approaches are not mentioned, paints an inaccurate picture. Similarly, we are concerned that studies showing advantages in survival with HSCT in certain disease states were brushed aside by speculation of bias.

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Authors and Affiliations

  1. Division of Hematology/BMT, Primary Children's Medical Center/University of Utah School of Medicine, Salt Lake City, UT, USA

    M A Pulsipher

  2. Center for Cancer and Blood Disorders, Children's Hospital, Denver, CO, USA

    S P Hunger

  3. Department of Hematology/Oncology, Children's Mercy Hospital, Kansas City, MO, USA

    A S Gamis

  4. Department of Pediatric Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada,

    D A Wall

  5. Division of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA

    S A Grupp

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  1. M A Pulsipher
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  2. S P Hunger
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  3. A S Gamis
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  4. D A Wall
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Correspondence to M A Pulsipher.

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Pulsipher, M., Hunger, S., Gamis, A. et al. Allogeneic marrow transplantation in children with acute leukemia: careful comparison with chemotherapy alternatives required. Leukemia 24, 1212–1216 (2010). https://doi.org/10.1038/leu.2010.72

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