Use of idarubicin in pre-transplant conditioning in children with high-risk acute leukaemia

The major cause of treatment failure following allogeneic bone marrow trans plantation for acute leukaemia is disease relapse. In an attempt to reduce posttransplant relapse in 33 children with high-risk acute leukaemia who re ceived a related or unrelated bone marrow transplant, the pre-transplant co nditioning regimen was intensified by the addition of idarubicin, Its toxic ity and effects on survival were evaluated over a 57-month period. Toxicity , largely gastrointestinal, was increased but acceptable, and there was no specific regimen-related toxicity. Relapse rates were low (24%) in this hig h risk group, but mortality was increased in those receiving unrelated dono r grafts, largely due to sepsis, Idarubicin does appear to have a role to p lay in the conditioning regimen of patients with high-risk acute leukaemia undergoing BMT, and may reduce relapse rates without increasing transplant- related mortality.