HEMATOPOIETIC-CELL TRANSPLANTATION IN CHILDREN WITH JUVENILE MYELOMONOCYTIC LEUKEMIA

Seven children, 11 months to 5.9 years of age, with juvenile myelomono cytic leukaemia (JMML) underwent allogeneic haemopoietic cell transpla ntation (HCT) using related or unrelated donor bone marrow or umbilica l cord blood. All patients had active disease at time of transplant de spite chemotherapy in five patients and chemotherapy and splenectomy i n one patient prior to HCT conditioning. All patients received cycloph osphamide and TBI, with the addition of busulphan in two cases. Engraf tment was documented in all cases. Notably six of seven patients relap sed after allogeneic HCT with one achieving a return to full donor chi maerism after cyclosporin A (CSA) withdrawal. Two patients are alive i n remission, 23+ and 30+ months after transplant. The role of allogene ic HCT in patients with JMML is discussed. A cooperative multicentre t rial is needed to establish the optimal therapy for these patients.