EARLY DEATHS IN CHILDREN UNDERGOING MARROW ABLATIVE THERAPY AND BONE-MARROW TRANSPLANTATION

We have reviewed the causes and risk factors for early death in a grou p of 295 children who underwent any form of first bone marrow transpla ntation (BMT) between 1978 and 1992. The commonest indications for tra nsplantation were acute lymphoblastic leukaemia 80 (27.1%), neuroblast oma 69 (23.3%), immune deficiency 57 (19.3%) and myeloid leukaemias/my elodysplasia 50 (16.9%), There were 120 (40.6%) allogeneic BMTs, 118 ( 40%) autologous BMTs, while 51 (17.2%) children usually with severe co mbine immune deficiency received BMT from a non-HLA-identical parent, sibling or other relative (FBMT), Two were from identical twins and fo ur from matched unrelated donors (MUD). Thirty-three children (11.2%) died in the first 100 days; the main causes of death being infection ( n = 5), relapse (n = 7), graft failure (n = 4), GVHD (n = 7) and organ failure with or without infection (n = 6). There was no significant c hange in the incidence of early deaths in the three successive 5 year periods (1978-82, 1983-87, 1988-92) although there was some shift in t he causes, Infections were the commonest cause during the first 5 year period, relapses followed by GVHD in the second period and single org an failure followed by GVHD and infections in the third period, The ma in causes of early death were relapse after high-dose chemo/radiothera py and autologous BMT (7 of 9 deaths) and GVHD and infection after all ogeneic BMT (9 of 13 deaths). In the group of 51 children undergoing F BMT there were five deaths from infection, three from graft failure, o ne from organ failure and one from GVHD. Analysis of the factors influ encing the risk of early death showed that only the type of transplant was of significance, the risk of early death being highest after fami ly BMT, This large study confirms the lower risk of early death after myeloblative therapy and BMT or autologous marrow rescue in the paedia tric age group compared with adults but highlights the continuing need for better methods of enabling engraftment while preventing GVHD.