ALLOGENEIC BONE-MARROW TRANSPLANTATION IN CHILDREN WITH ACUTE MYELOGENOUS LEUKEMIA IN FIRST REMISSION

Fifty-nine children, aged 1-15 years, with acute myelogenous leukemia (AML) received a bone marrow transplant (BMT) from an HLA-identical si bling (n = 57) or from an identical twin (n = 2), while in first remis sion (CR). These children represent, to the best of our knowledge, all children grafted in first CR in 11 Italian centers between 1980 and 1 990. Patients were prepared with total body irradiation (TBI) plus cyc lophosphamide (CY) (n = 50) or melphalan (n = 2) or with busulfan plus CY (n = 7), GVHD prophylaxis consisted of cyclosporin A (n = 48), met hotrexate (n = 7) or cyclosporin and methotrexate (n = 2). Survivors h ave been followed for 21-137 months (median 59 months). Actuarial rela pse-free survival was 58% at 66-137 months (95% confidence interval (C I) 44-72). Actuarial risk of relapse was 23% at 48 months (95% CI 10.9 -34.8). Risk of non-relapse deaths was 33% in the period 1980-87 and 4 % in the period 1988-90 (p = 0.02). In multivariate analysis patients with a blood cell count > 14 X 10(9)/l at diagnosis showed a lower rel apse-free survival compared with patients with counts < 14 X 10(9)/l ( p = 0.006). We could not detect an effect of FAB subtype, patient age, time to achieve remission or transplant-related variables, including year of BMT, on relapse-free survival. In conclusion, allogeneic marro w transplantation can achieve longterm relapse-free survival in over 5 0% of children with AML and should be considered as consolidation ther apy if a matched sibling is available. Patients with high white blood cell count at diagnosis may benefit from more intensive consolidation chemotherapy before transplantation.