RELAPSED ACUTE LYMPHOBLASTIC-LEUKEMIA - SIMILAR OUTCOMES FOR AUTOLOGOUS AND ALLOGENEIC MARROW TRANSPLANTATION IN SELECTED CHILDREN

The therapy of choice for relapsed childhood acute lymphoblastic leuke mia is controversial, We retrospectively compared the outcome of 57 pa tients who received autologous bone marrow transplantation (BMT) with 17 patients who underwent allogeneic BMT for B cell lineage acute lymp hoblastic leukemia after at least one marrow relapse. The allogeneic B MT cohort included only those who would also have been eligible for au tologous BMT had they not had a matched sibling donor. Specifically, p atients who were not in complete remission, those with T cell positive leukemia, t(9;22) or those with only an extramedullary relapse were e xcluded from both groups, Conditioning regimens included total body ir radiation and chemotherapy. Age, white blood count at diagnosis, and d uration of first and longest complete remissions were comparable for t he two groups, The median follow-up of the event-free survivors was 4. 8 years for those who received an autologous BMT (n = 26) and 4.6 year s for those who received an allogeneic BMT (n = 8), The relapse rate w as higher in the autologous BMT group and the incidence of nonleukemic deaths higher in the allogeneic BMT group. Event-free survival at 3 y ears was comparable for the two groups (47% +/- 7 vs 53% +/- 12, autol ogous vs allogeneic, respectively; P = 0.77), Based upon these finding s, we concluded that the outcome for autologous BMT was equivalent to allogeneic BMT for relapsed childhood B cell lineage acute lymphoblast ic leukemia in selected clinical situations.