Autologous bone marrow transplantation with monoclonal antibody purged marrow for children with acute lymphoblastic leukemia in second remission

The purpose of this study was to evaluate the outcome of children with acut e lymphoid leukemia (ALL) in second remission who have undergone high-dose chemotherapy and radiotherapy and autologous bone marrow transplantation (A BMT) with monoclonal antibody purged marrow, and to determine the main prog nostic factors. From 1987 to 1992, 55 children with ALL in second remission underwent ABMT, The conditioning regimen consisted of total body irradiati on (TBI) plus cyclophosphamide in 21 patients and TBI plus cyclophosphamide plus cytarabine or VP-16 in 28 patients; the remaining six patients were t reated with chemotherapy alone (cyclophosphamide and busulfan, and/or VP-16 ), The marrow was purged using monoclonal antibodies and complement or magn etic microspheres in all cases. All patients engrafted, Three patients (5%) died early past transplant from infections. Twenty-six patients (47%) rela psed (median 150 days); 26 patients (47%) are alive and in complete remissi on (CR) at a median of 36 months, The Kaplan-Meier estimation showed a prob ability of event-free survival (EFS) of 46 +/- 0.007%. In the univariate an alysis, first CR length and conditioning with TBI plus two or more cytotoxi c drugs were found to be the most significant predictors of EFS, ABMT with purged marrow is a treatment modality which offers a chance of cure in chil dren with ALL after relapse, including children who relapse early.