ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA IN 2ND REMISSION - FACTORS PREDICTIVE OF SURVIVAL, RELAPSE AND GRAFT-VERSUS-HOST DISEASE

Between 1983 and 1993, 42 patients with acute lymphoblastic leukemia ( ALL) in second complete remission (CR) underwent an allogeneic HLA-ide ntical bone marrow transplant (BMT; there was one family mismatched gr aft). The conditioning regimens varied, consisting of cyclophosphamide (CY) and total body irradiation (TBI; n = 10); CY, TBI, Ara C, VP-16 (n = 11); TBI, Ara C, melphalan (n = 20) (TAM) or other (n = 1). Cyclo sporine A (CsA) (n = 15) or CsA and methotrexate (MTX) (n = 24) were t he main regimens for prophylaxis of graft-versus-host disease (GVHD). Nineteen of 42 patients are alive in CR ranging from 1 to 72 months af ter BMT with a median follow-up of 36 months. The 4-year actuarial sur vival rate was 53%. The actuarial relapse rate was 17%. Twenty three p atients died: 4 patients of leukemic relapse, 9 of infection, 2 of acu te GVHD, 2 of multiorgan failure after chronic GVHD, 2 of a secondary tumour and 4 patients died of other causes. Several pre- and post-tran splant characteristics were analyzed to determine predictive factors f or survival, relapse and GVHD. The relapse rate was significantly infl uenced by the type of conditioning regimen with no relapse in the TBI, Ara C, melphalan group. The analysis of long-term sequelae shows that there are no severe complications in this last group. Our results con firm that allogeneic BMT can lead to long-term survival for children w ith ALL in second CR and suggest an advantage of using the TAM conditi oning regimen in the eradication of the leukemic disease.