UNRELATED DONOR BONE-MARROW TRANSPLANTATION FOR CHILDREN WITH ACUTE-LEUKEMIA

Purpose: To test the use of unrelated donor bone marrow transplantatio n (URD BMT) to cure children with high-risk acute leukemias. Patients cmd Methods: Between June 1985 and December 1994, 50 children with acu te leukemia (15 acute myelogenous leukemia [AML], 35 acute lymphoblast ic leukemia [ALL]; 22 greater than second complete remission [CR]) rec eived BMT from a URD at the University of Minnesota. Ages ranged from 0.9 to 17.5 years (median, 8.8). Median follow-up is 2.1 years (range, 1 to 7.3). Thirty patients (60%) received bone marrow fully matched a t HLA-A,B and DRB1; 20 (40%) received bone marrow with a major or mino r mismatch at a single HLA-A or B locus. Results: The median time to n eutrophil engraftment was day 24 (range, 14 to 42 days) in those recei ving matched and day 25 (range, 15 to 32 days) in those receiving mism atched marrow (P = .35). The incidence of grades III to IV graft-versu s-host disease (GVHD) was 23% (95% confidence interval [CI], 7% to 39% ) in matched and 32% (95% CI, 8% to 52%) in HLA-mismatched patients (P = .57). The incidence of chronic GVHD was 50% (95% CI, 28% to 72%) in matched and 57% (95% CI, 23% to 91%) in mismatched patients (P = .80) . Disease-free survival for patients with ALL is 37% (95% CI, 21% to 5 3%) at 1 year and 30% (95% CI, 15% to 46%) at 2 years; for patients wi th AML, 53% (95% CI, 28% to 78%) at 1 year and 33% (95% CI, 6% to 60%) at 2 years. Conclusion: URD BMT is an effective treatment for childre n with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended . (C) 1997 by American Society of Clinical Oncology.