ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHILDHOOD LEUKEMIA FOLLOWING A BUSULFAN AND MELPHALAN PREPARATIVE REGIMEN

Thirty children with leukemia underwent allogeneic bone marrow transpl antation (BMT) following a radiation-free preparative regimen, from Ju ly 1988 to January 1996, Twelve males and 18 females, ages 9 months to 15 years (median 8.5 years), received busulfan (BU, 4 mg/kg/day for 4 days by mouth), followed by melphalan (L-PAM, 60-70 mg/m(2)/day i,v, for 3 days), and infusion of allogeneic marrow from an HLA-matched rel ated donor. Diagnoses included acute myelogenous leukemia (n = 20), ac ute lymphoblastic leukemia (n = 8) and chronic myelogenous leukemia (n = 2), Twenty-five patients were transplanted in first complete remiss ion (CR), three in second CR, and two patients with chronic myelogenou s leukemia in the first chronic phase, Graft-versus-host disease (GVHD ) prophylaxis consisted of methotrexate (MTX) alone in 27 patients and short-term MTX and cyclosporin A in three patients. Engraftment was a chieved in all patients. Toxicities were mild or moderate. Six patient s developed acute GVHD: four had grade I and two had grade II. Chronic GVHD was documented in eight patients. Three patients relapsed, As of September 1997, 27 patients were alive and well at 22- 110 months (me dian 61) of follow-up. The disease-free survival rate at 5 years after BMT was 90%, A regimen consisting of high-dose BU and L-PAM without t otal body irradiation is useful for conditioning for allogeneic BMT in children with leukemia.