Bone marrow transplantation for therapy-induced acute myeloid leukemia in children with previous lymphoid malignancies

Twenty-one children who developed therapy-related acute myeloid leukemia af ter treatment for acute lymphoblastic leukemia received allogeneic bone mar row transplants between January 1990 and June 1997. All had previously rece ived epipodophyllotoxin-containing regimens and 11 had cytogenetic abnormal ities involving 11q23. Induction chemotherapy was given to 13 patients and eight patients went directly to BMT, Eleven received marrow from matched si blings, eight from matched unrelated donors and two from haploidentical fam ily members. Conditioning regimens included cyclophosphamide (CY), cytarabi ne, and total body irradiation. Four patients are alive disease-free betwee n 1118 and 1825 days post-BMT resulting in a 3-year DFS of 19%. Ten patient s relapsed at a median of 150 days (range 30-664 days) post-BMT and all eve ntually died of disease, Seven patients died of regimen-related toxicity. T he outlook for patients with therapy-related AML/MDS remains poor and more effective therapy is needed.