AUTOLOGOUS BONE-MARROW TRANSPLANTS COMPARED WITH CHEMOTHERAPY FOR CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA IN A 2ND REMISSION - A MATCHED-PAIR ANALYSIS
A. Borgmann et al., AUTOLOGOUS BONE-MARROW TRANSPLANTS COMPARED WITH CHEMOTHERAPY FOR CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA IN A 2ND REMISSION - A MATCHED-PAIR ANALYSIS, Lancet, 346(8979), 1995, pp. 873-876
It is unclear how best to treat children with acute lymphoblastic leuk
aemia (ALL) who are in a second remission. Treatment with bone-marrow
transplants from HLA-identical siblings results in a statistically gre
ater likelihood of leukaemia-free survival than does chemotherapy. Les
s than 25% of relapsed patients are able to benefit from this therapy
due to a lack of matching donors; chemoradiotherapy or autologous BMT
are considered for the rest. We compared treatment results for childre
n who underwent autologous BMT those who had chemotherapy. All patient
s were registered between 1983-94 in the multicentre trials. We select
ed groups of patients by matching variables associated with treatment
outcome and duration of second remission. 52 matched-pairs were studie
d. The probability of event-free survival at 9 years was 0.32 (SD 0.07
) for patients receiving chemotherapy versus 0.26 (SD 0.07) for patien
ts who underwent autologous BMT. For two groups-children with prognost
ic factors indicating high risk of relapse and those with factors indi
cating lower risk-the outcome from transplantation did not differ sign
ificantly from that of chemotherapy: no advantage of autologous BMT ov
er chemotherapy as post-induction treatment for children with ALL in a
second remission could be detected with regard to event-free survival
. Because autologous BMT has been used as the final step of treatment
it is possible that its relative ineffectiveness has been due to the l
ack of continuation therapy after transplant. Attempts should be made
to complement autologous BMT by subsequent immunotherapy, molecular bi
otherapy, chemotherapy, or a combination of these.