Jj. Ortega et T. Olive, HEMATOPOIETIC PROGENITOR-CELL TRANSPLANT IN ACUTE LEUKEMIAS IN CHILDREN - INDICATIONS, RESULTS AND CONTROVERSIES, Bone marrow transplantation, 21, 1998, pp. 11-16
The objective of this study was to update the role of different modali
ties of haematopoietic progenitor cell transplants (PCT) in the therap
y of acute leukaemias in children emphasizing the points of agreement
and controversy. In ARIL in first remission, allogeneic PCT from an HL
A-identical sibling is the treatment of choice in most cases, DFS of 6
0-80% has been attained in paediatric series, Indications appear clear
except in M3 subtype, M7 in children with Down syndrome and possibly
in patients with M2 and t(8;21) and M5-Eo and inv(16) who have a good
early response to; induction treatment. In some paediatric series, res
ults with autologous transplants (APCT) are similar to those obtained
with allo-PCT and superior to those obtained with chemotherapy alone,
but this point is controversial. Allo-PCT and APCT are indicated in ch
ildren in second remission, yielding 40% DFS, In children with ALL in
first remission, indications for PCT are limited to only 8-10% of pati
ents with very-high risk of relapse, mainly those with certain chromos
ome abnormalities or with poor or late response to induction treatment
; a favourable outcome has been registered in 60%, Allo-PCT is the bes
t choice for patients in second remission after an early marrow relaps
e and who have an adequate related or unrelated donor; DFS of 40-50% h
as been described in several paediatric series. Indications of allo-PC
T from related donors after late bone marrow relapses or early extrame
dullary relapses appears more controversial but there are data in its
favour. The role of APCT appears even more controversial but some auth
ors favour its use in these situations. In more advanced stages of the
disease the results obtained with allo-PCT are poorer (DFS between 10
and 20%), In summary, although many controversial points with regards
to indications and modalities of transplants in acute leukaemia in ch
ildren remain, it must be emphasized that with advances in both fields
, chemotherapy and transplants, today 80% of children with ALL and 60-
70% of those with AML are cured and enjoy good quality of life.