Allogeneic bone marrow transplantation in children failing prior autologous bone marrow transplantation

Twenty-three children with de novo acute myelogenous leukemia (AML) (n = 20 ), secondary AML (n = 1), or non-Hodgkin's lymphoma (NHL) (n = 2) underwent allogeneic bone marrow transplantation (alloBMT) for graft failure (n = 1) or recurrent malignancy (n = 22) between February 1992 and August 1999 fol lowing autologous BMT (ABMT). Induction chemotherapy was given to 14 patien ts and nine patients went directly to alloBMT. Five received marrow from ma tched siblings, 14 from matched unrelated donors and four from mismatched f amily members. Conditioning regimens included cyclophosphamide, cytarabine, and total body irradiation, Nine patients are alive disease-free between 6 27 and 2433 days (1.7-6.7 years) post BMT resulting in a 4-year DFS of 39%. Eight patients relapsed at a median of 206 days (range, 35-669 days) post alloBMT and all eventually died. Eight patients (two of whom also relapsed) died of RRT, Although RRT and relapse remain significant problems, a signi ficant percentage of pediatric patients failing ABMT may be cured with allo BMT.