Marrow transplant experience in children with acute lymphoblastic leukemia: An analysis of factors associated with survival, relapse, and graft-versus-host disease

Authors

  • Jean E. Sanders MD,

    Corresponding author
    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
    • Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104
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  • Nancy Flournoy PhD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • E. Donnall Thomas MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • C. Dean Buckner MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • Lawrence G. Lum MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • Reginald A. Clift FIMLS,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • Frederick R. Appelbaum MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • Keith M. Sullivan MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • Patricia Stewart MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • H. Joachim Deeg MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • Kristine Doney MD,

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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  • Rainer Storb MD

    1. Fred Hutchinson Cancer Research Center, The Children's Orthopedic Hospital and Medical Center, and the Departments of Medicine Pediatrics, and Biostatistics, University of Washington School of Medicine, Seattle
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Abstract

One hundred fourteen children with acute lymphoblastic leukemia were treated with allogeneic marrow transplantation from HLA-identical siblings after conditioning with cy-clophosphamide and total body irradiation. Methotrexate was given posttransplantation for prophylaxis of graft-versus-host disease. The minimum follow-up after transplantation was 2 years. Sixteen of 51 patients transplanted in marrow remission survive from 2.1 to 8.9 years (median 2.7), 13 in continuous remission, one in remission following testicular relapse, and two after marrow relapse. Sixty-three were transplanted in relapse and eight survived 3–10 years (median 5.7), five in continuous remission, and three in remission following testicular relapse. In a multivariate analysis, factors significantly related to increased survival were marrow remission at transplant (p < 0.007) and chronic graft-versus-host disease (p < 0.005). Factors associated with increased relapse were marrow relapse at transplant (p < 0.002) and absence of significant graft-versus-host disease (p < 0.004). The development of acute graft-versus-host disease was associated with high marrow cell doses (p < 0.04). These data suggest that some children with acute lymphoblastic leukemia and a poor prognosis with conventional chemotherapy may be cured with marrow transplantation.

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