AUTOLOGOUS BONE-MARROW TRANSPLANTS COMPARED WITH CHEMOTHERAPY FOR CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA IN A 2ND REMISSION - A MATCHED-PAIR ANALYSIS

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.