ALLOGENEIC BONE-MARROW TRANSPLANTATION FOLLOWING BUSULFAN-CYCLOPHOSPHAMIDE WITH OR WITHOUT ETOPOSIDE CONDITIONING REGIMEN FOR PATIENTS WITHACUTE LYMPHOBLASTIC-LEUKEMIA

We have investigated the feasibility and efficacy of administering a r adiation-free preparative regimen in the setting of allogeneic bone ma rrow transplantation (BMT) in 40 consecutive patients with acute lymph oblastic leukaemia (ALL). Busulfan (4 mg/kg/d x 4 d) and cyclophospham ide (50 mg/kg/d x 4 d) (BuCy4) were given in 29 patients and 11 receiv ed busulfan (4 mg/kg/d x 4 d), etoposide (60 mg/kg) and cyclophosphami de (60 mg/kg/d x 2 d) (BuCy + VP-16). Median age was 22 years (range 1 -50); 11 patients were children less-than-or-equal-to 15 years of age. All children and 20 adults were at high risk of relapse pretransplant . Nine adults and one child died from transplant-related toxicity. 11 patients relapsed at a median of 11 months post-transplant (range 2-27 ). The 3-year Kaplan-Meier estimated probability of relapse was 42.1% and found to be significantly lower in patients with chronic GVHD (P=0 .03). 19 patients are leukaemia-free survivors with a median follow-up of 33 months (range 7-59). The Kaplan-Meier actuarial probability of disease-free survival at 3 years was 43% for all patients, 63.6% for c hildren versus 30.2% for adults (P=0.24) and 51.6% for patients transp lanted in first remission versus 30.2% for those transplanted in subse quent remissions (P=0.20).