Allogeneic bone marrow transplantation versus chemotherapy in high-risk childhood acute lymphoblastic leukaemia in first remission. Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) and the Gruppo Italiano Trapianto di Midollo Osseo (GITMO)
| Autor: | C, Uderzo, M G, Valsecchi, A, Balduzzi, G, Dini, R, Miniero, F, Locatelli, R, Rondelli, A, Pession, W, Arcese, A, Bacigalupo, P, Polchi, M, Andolina, C, Messina, V, Conter, M, Aricó, S, Galimberti, G, Masera |
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| Přispěvatelé: | Uderzo, C, Valsecchi, M, Balduzzi, A, Dini, G, Miniero, R, Locatelli, F, Rondelli, R, Pession, A, Arcese, W, Bacigalupo, A, Polchi, P, Andolina, M, Messina, C, Conter, V, Aricó, M, Galimberti, S, Masera, G |
| Jazyk: | angličtina |
| Rok vydání: | 1997 |
| Předmět: |
Male
Transplantation Conditioning Graft vs Host Disease Antineoplastic Agents Follow-Up Studie Cohort Studies Antineoplastic Agent Risk Factors Recurrence Humans Transplantation Homologous Child Transplantation Homologou Bone Marrow Transplantation Risk Factor Graft Survival Infant Precursor Cell Lymphoblastic Leukemia-Lymphoma Survival Analysis Survival Rate Treatment Outcome Child Preschool Female Survival Analysi Cohort Studie Follow-Up Studies Human |
| Popis: | We compared the outcome of children with high-risk acute lymphoblastic leukaemia (HR-ALL) in first complete remission (first CR) treated with chemotherapy (CHEMO) or with allogeneic bone marrow transplantation (BMT) in a multicentre study. All children treated by the Italian Paediatric Haematology Oncology Association for HR-ALL in first CR between 1986 and 1994 were eligible for the study. 30 children were given BMT at a median of 4 months from first CR, with preparative regimens including total-body irradiation (n = 25/30). 130 matched controls for BMT patients were identified among 397 HR-ALL CHEMO patients. Matching on main prognostic factors and duration of first CR was adopted to control the selection and time-to-transplant biases. The comparative analysis was based on the results of a stratified Cox model. The estimated hazard ratios of BMT versus CHEMO at 6 months, 1 year and 2 years after CR were 1.38 (CI 0.59-3.24), 0.69 (CI 0.27-1.77) and 0.35 (CI 0.06-1.91), with an overall non-significant difference between the two groups (P = 0.34). With a median follow-up of 4 years, the disease-free survival was 58.5% (SE 9.3) in the BMT group and 47.7% (SE 4.8) in the CHEMO group, at 4 years from CR. Non-leukaemic death occurred in 4% of CHEMO and 10% of BMT patients. In the BMT group the estimated cumulative incidence of relapse at 1.5 years from CR was 31.5% (SE 8.8) and did not change thereafter, whereas in the CHEMO group the corresponding figure was 29.2% (SE 4.1) and the incidence continued to increase thereafter (48.2% (SE 4.8) at 4 years from CR). The results of this study suggest that, with respect to the CHEMO group, the higher risk of early failure in the BMT group is outweighed by the lower risk of relapse after 1 year. Results prompt the need for a prospective study, in order to demonstrate the likely advantage of BMT in HR childhood ALL in first CR. |
| Databáze: | OpenAIRE |
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