INTENSIFIED CONDITIONING REGIMEN WITH BUSULFAN FOLLOWED BY ALLOGENEICBMT IN CHILDREN WITH MYELODYSPLASTIC SYNDROMES

Four consecutive children with myelodysplastic syndromes (MDS) underwe nt matched allogeneic bone marrow transplantation (BMT). Ages ranged f rom 3.2 to 6.3 years. Diagnosis was assessed according to FAB classifi cation: refractory anemia-RA (n = 1), RA with excess of blasts (RAEB) (n = 1), and juvenile chronic myelogenous leukemia (JCML) (n = 2). Ini tial treatment included transfusions for all of them, splenectomy (n = 2) and chemotherapy (n = 1). Patients were all prepared with busulfan 21 mg/kg (480 mg/m(2)), cytosine arabinoside 24 000 mg/m(2), melphala n 140 mg/m(2). Graft-versus-host disease (GVHD) prophylaxis associated cyclosporine-methotrexate. Engraftment was prompt and complete in all children. Toxicity included severe mucositis (n = 3), moderate veno-o cclusive disease (n = 2), acute GVHD (n = 3), chronic GVHD (n = 1). Se quelae have not yet been seen. All patients are alive and disease-free with a follow-up ranging from 7 to 35 months, with a Karnofsky score of 90-100%. Combined busulphan conditioning can offer an alternative t o total body irradiation-based regimens in order to avoid late side-ef fects in children.