High survival rate in infant acute leukemia treated with early high-dose chemotherapy and stem-cell support

Purpose: infants with acute leukemia have a poor prognosis when treated wit h conventional chemotherapy, It is still unknown if stem-cell transplantati on (SCT) can improve the outcome of these patients. In the present study, w e review our experience with SCT in infant acute leukemia to clarify this i ssue. Patients and Methods: We report the results of 26 infants who were submitte d to a SCT for acute leukemia. There were 15 cases of acute myeloid leukemi a and 10 eases of acute lymphoid leukemia. One patient had a bilineal leuke mia. Twenty-two patients were in their first complete response (CR1), three were in their second CR, and one was in relapse. Eight patients were submi tted to allogeneic SCT, and 18 underwent autologous SCT. Results: With a median follow-up of 67 months, the 5-year overall survival and disease-free survival (DFS) are 64% (SE = 9%) and 63% (SE = 10%), respe ctively, Autologous and allogeneic SCT offered similar outcome. There was n ot any transplant-related mortality, and all deaths were caused by relapse in the first 6 months after SCT. In multivariate analysis,:the single facto r associated with better DFS was an interval between CRI and SCT of less th an 4 months (P less than or equal to .025). Conclusion: SCT is a valid option in the treatment of infant acute leukemia , and it may overcome the high risk of relapse with conventional chemothera py showing very reduced toxicity. This study suggests that SCT should be pe rformed in CR1 in the early phase of the disease. (C) 2000 by American Soci ety of Clinical Oncology.