Case-control analysis of allogeneic bone marrow transplantation versus maintenance chemotherapy for relapsed ALL in children

P. M. Hoogerbrugge, E. J.A. Gerritsen, A. Vd Does van den Berg, H. Vd Berg, A. H. Zwinderman, J. Hermans, J. M.J. Vossen

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28 Citations (Scopus)

Abstract

In a retrospective study, the results of maintenance chemotherapy and allogeneic bone marrow transplantation (BMT) for children who reached a second complete remission (CR2) of their acute lymphoblastic leukemia (ALL) were compared. Case-control analysis was performed comparing 25 allogeneic transplant patients (cases) with 97 patients treated with maintenance chemotherapy (controls), who were matched for site of relapse, duration of CR1 and leukemia-free interval from onset of CR2. Until the first relapse, the children were treated according to standard protocols. The majority of patients suffered from a bone marrow relapse, mostly occurring more than 24 months after the onset of CR1. Remission reinduction treatment was heterogeneous. Patients treated with allogeneic BMT received high-dose chemotherapy and total body irradiation prior to BMT. Maintenance chemotherapy in controls was given for approximately 2 years. Following BMT, relapse rate was lower but the treatment-related mortality was higher compared with maintenance chemotherapy, resulting in leukemia-free survival rates at 4 years of 44% and 24%, respectively (not significant, NS). Case-control analysis of leukemia-free survival showed a hazard ratio of 0.756 in favor of BMT compared with chemotherapy (NS). If bone marrow relapses and central nervous system relapses were analyzed separately, a tendency to better leukemia-free survival was present after BMT compared with maintenance chemotherapy for patients with a relapse in the central nervous system, but for an isolated bone marrow relapse, no differences in leukemia-free survival were seen between the two groups of patients.

Original languageEnglish
Pages (from-to)255-259
Number of pages5
JournalBone Marrow Transplantation
Volume15
Issue number2
Publication statusPublished - 1995
Externally publishedYes

Keywords

  • ALL
  • BMT
  • Chemotherapy
  • Relapse

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