PURPOSE: To compare conventional sibling bone marrow transplantation (CBMT), BMT with alternative donor (ABMT), and chemotherapy (CT) for children with acute lymphoblastic leukemia (ALL) and an early first marrow relapse. PATIENTS AND METHODS: After informed consent, 214 patients with ALL and early marrow relapse began multiagent induction therapy. One hundred sixty-three patients with fewer than 25% marrow blasts and count recovery at the end of induction (second remission [CR2]) were allocated by donor availability. Fifty patients with sibling donors were allocated to CBMT. Seventy-two patients were randomly allocated between ABMT and CT while 41 patients refused allocation. RESULTS: Overall, 3-year event free survival from entry is 19% +/- 3%. Thirty-two of 50 CBMT patients (64%) and 19 of 37 ABMT patients (51%) underwent transplantation in CR2 with 3-year disease-free survival of 42% +/- 7% and 29% +/- 7%. The 3-year DFS is 29% +/- 7%, 21% +/- 7%, and 27% +/- 8% for patients allocated to CBMT, ABMT, and CT, respectively. Contrary to protocol, 12 of 35 patients allocated to CT underwent BMT in CR2. Of these, five patients died after BMT and 5 patients relapsed. CONCLUSION: More than one half of patients died, failed reinduction, or relapsed again before 3 months after CR2 (median time to BMT). Intent-to-treat pair-wise comparison of ABMT with CT, CT with CBMT, and CBMT with ABMT yields hazards of 1.2, 1.1, 0.8 with P values of .56, .80, and .36, respectively. Outcomes remain similar and poor for children with ALL and early marrow relapse. BMT is not a complete answer to the challenge of ALL and early marrow relapse.
RCT Entities:
PURPOSE: To compare conventional sibling bone marrow transplantation (CBMT), BMT with alternative donor (ABMT), and chemotherapy (CT) for children with acute lymphoblastic leukemia (ALL) and an early first marrow relapse. PATIENTS AND METHODS: After informed consent, 214 patients with ALL and early marrow relapse began multiagent induction therapy. One hundred sixty-three patients with fewer than 25% marrow blasts and count recovery at the end of induction (second remission [CR2]) were allocated by donor availability. Fifty patients with sibling donors were allocated to CBMT. Seventy-two patients were randomly allocated between ABMT and CT while 41 patients refused allocation. RESULTS: Overall, 3-year event free survival from entry is 19% +/- 3%. Thirty-two of 50 CBMT patients (64%) and 19 of 37 ABMT patients (51%) underwent transplantation in CR2 with 3-year disease-free survival of 42% +/- 7% and 29% +/- 7%. The 3-year DFS is 29% +/- 7%, 21% +/- 7%, and 27% +/- 8% for patients allocated to CBMT, ABMT, and CT, respectively. Contrary to protocol, 12 of 35 patients allocated to CT underwent BMT in CR2. Of these, five patients died after BMT and 5 patients relapsed. CONCLUSION: More than one half of patients died, failed reinduction, or relapsed again before 3 months after CR2 (median time to BMT). Intent-to-treat pair-wise comparison of ABMT with CT, CT with CBMT, and CBMT with ABMT yields hazards of 1.2, 1.1, 0.8 with P values of .56, .80, and .36, respectively. Outcomes remain similar and poor for children with ALL and early marrow relapse. BMT is not a complete answer to the challenge of ALL and early marrow relapse.
Authors: Karen L Bride; Tiffaney L Vincent; Soo-Yeon Im; Richard Aplenc; David M Barrett; William L Carroll; Robin Carson; Yunfeng Dai; Meenakshi Devidas; Kimberly P Dunsmore; Tori Fuller; Tina Glisovic-Aplenc; Terzah M Horton; Stephen P Hunger; Mignon L Loh; Shannon L Maude; Elizabeth A Raetz; Stuart S Winter; Stephan A Grupp; Michelle L Hermiston; Brent L Wood; David T Teachey Journal: Blood Date: 2018-01-05 Impact factor: 22.113
Authors: Takaya Moriyama; Shuguang Liu; Jing Li; Julia Meyer; Xujie Zhao; Wentao Yang; Youming Shao; Richard Heath; Aleš Hnízda; William L Carroll; Jun J Yang Journal: Mol Cancer Ther Date: 2019-07-29 Impact factor: 6.261
Authors: Prakash Satwani; Harland Sather; Fevzi Ozkaynak; Nyla A Heerema; Kirk R Schultz; Jean Sanders; John Kersey; Virginia Davenport; Michael Trigg; Mitchell S Cairo Journal: Biol Blood Marrow Transplant Date: 2007-02 Impact factor: 5.742
Authors: Elizabeth A Raetz; Mitchell S Cairo; Michael J Borowitz; Susan M Blaney; Mark D Krailo; Tarek A Leil; Joel M Reid; David M Goldenberg; William A Wegener; William L Carroll; Peter C Adamson Journal: J Clin Oncol Date: 2008-08-01 Impact factor: 44.544