LATE EFFECTS OF ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHILDREN WITH ACUTE MYELOBLASTIC-LEUKEMIA IN FIRST COMPLETE REMISSION - THE IMPACT OF CONDITIONING REGIMEN WITHOUT TOTAL-BODY IRRADIATION - A REPORT FROM THE SOCIETE-FRANCAISE-DE-GREFFE-DE-MOELLE

Purpose: To evaluate growth, thyroid function, puberty, cardiac functi on, and the incidence of cataracts in children who received allogeneic bone marrow transplantation (BMT) for acute myeloblastic leukemia (AM L) in first complete remission (CR) after a preparation with or withou t total-body irradiation (TBI). Patients and Methods: Among 45 childre n studied, 26 received busulfan-cyclophosphamide (Bu-Cy) in preparatio n for transplantation and 19 received TBI, TBI was fractionated in nin e cases and delivered as a single dose in TO, Four children in the Bu- Cy group and none in the TBI group had received prior cranial radiatio n, The mean follow-up duration after BMT was 5.9 years for the whole g roup, Results: The mean cumulative changes in height SD score (SDS) we re -0.86 at 3 years and -1.56 at 5 years in the TBI group, whereas the se changes were only -0.05 and -0.17 in the Bu-Cy group (P <.01 at 3 a nd 5 years). The 6-year probability of hypothyroidism was 9% +/- 8% in the Bu-Cy group and 43% +/- 15% after TBI (P < .02), Pubertal develop ment after Bu-Cy was assessable in two girls and five boys: both girls had primary ovarian failure, whereas Leydig cell function appeared to be preserved in the five boys. One child who had received anthracycli ne when he was less than 1 year old developed cardiac dysfunction 4 ye ars after Bu-Cy. The 6-year probability of cataracts wets 70% +/- 13% in the TBI group and 0% after Bu-Cy. Conclusion: The use of Bu-Gy repr esents an alternative transplant cytoreductive regimen for children wi th AML in first CR, which can reduce the risk of posttransplant growth impairment, thyroid dysfunction, Leydig cell damage, and the incidenc e of cataracts. (C) 1997 by American Society of Clinical Oncology.