UNRELATED DONOR BONE-MARROW TRANSPLANTATION FOR CHILDREN AND ADOLESCENTS WITH PHILADELPHIA-POSITIVE ACUTE LYMPHOBLASTIC-LEUKEMIA

purpose: Few patients with Philadelphia-positive acute lymphoblastic l eukemia (Ph-positive ALL) have been cured by chemotherapy alone. Regis try figures show that 38% of patients who have a matched-sibling bone marrow transplant (BMT) are disease-free 2 years after transplant, but the majority of patients lack a sibling donor. Most modern ALL protoc ols recommend unrelated donor (UD) BMT for patients with Ph-positive A LL in first complete remission (CR1), but the outcome of this is unkno wn. Patients and Methods: We report the results of 15 children and ado lescents who had a T-cell depleted UD-BMT for Ph-positive ALL. Thirtee n of 15 had been previously treated on United Kingdom ALL protocols. N ine were in CR1 and six had more advanced disease. Eleven donor recipi ent pairs were matched at HLA-A, HLA-B, HLA-DR, and HLA-DQ, and four w ere mismatched at one or two HLA loci. Results: The incidence of great er than grade I acute and chronic graft-versus-host disease (GVHD) was low (13% and 8%, respectively). Six patients have relapsed and seven patients survive at a median of 21 months post-BMT; six of seven are d isease free. All seven survivors are in full-time education or work. T he 2-year overall and disease-free survivals are 44% +/- 13% and 37% /- 13% (+/-SE). None of four patients who had mismatched donors surviv ed, but seven of 11 matched recipients survive (P < .05). Conclusion: UD-BMT can produce prolonged disease-free survival in young patients w ith Ph-positive ALL who otherwise would have an extremely poor outlook . (C) 1998 by American Society of Clinical Oncology.