Allogeneic bone marrow transplantation vs chemotherapy for the treatment of childhood acute lymphoblastic leukaemia in second complete remission (revisited 10 years on)

In 1989 we carried out a trial comparing allogeneic BMT to chemotherapy (CT ) in 76 children with relapsed acute lymphoblastic leukaemia (ALL). Ten yea rs on we have clinically revised outcome to firmly establish the role of ea ch treatment, to analyse the importance of length of first remission and to provide long-term actuarial results for disease-free survival (DFS) and re lapse rate in each group. For 21 patients within the transplantation group, probability of DFS and relapse are 42.8 +/- 10.8% and 40.2 +/- 11.7% (s.e. ), respectively. In the chemotherapy group, probability of DFS is 10.0 +/- 4.74% (P = 0.001) and probability of relapse 87.5 +/- 5.2% (P = 0.0004), Th ese results strongly reflect those at initial analysis, confirming a key ro le of BMT in the management of ALL in second remission. Moreover, on univar iate analysis only two factors influenced DFS: treatment group and length o f first complete remission (less or more than 30 months from first CR). Thu s, it seems clear that the best therapeutic option in early relapse is BMT, whereas DFS in late relapse is at the limit of significance (P = 0.07), wi th a higher relapse rate in the CT group. Although encouraging results usin g intensified rotational combination chemotherapy have been published, pros pective randomised studies are needed to assess with certainty the best the rapeutic option in these patients.