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Blood, 15 May 2003, Vol. 101, No. 10, pp. 3835-3839
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Unrelated donor stem cell transplantation compared with
chemotherapy for children with acute lymphoblastic leukemia in a second
remission: a matched-pair analysis
Anja Borgmann,
Arend von Stackelberg,
Reinhard Hartmann,
Wolfram Ebell,
Thomas Klingebiel,
Christina Peters, and
Günter Henze for the Berlin-Frankfurt-Münster
Relapse Study Group
From the Department of Pediatric Hematology and
Oncology and the Medical Center Charité, Humboldt University of
Berlin, Germany; Johann Wolfgang Goethe University, Frankfurt, Germany;
and Children's Hospital St Anna, Wien, Austria.
Allogeneic stem cell transplantation (SCT) is frequently considered
as treatment for relapsed childhood acute lymphoblastic leukemia (ALL).
For patients without a matched sibling donor, SCT from unrelated donors
(UD-SCT) has been increasingly performed during the past years.
However, UD-SCT-related mortality and morbidity is still considerable,
and the question remains as to which patients are at such high risk of
recurrence that UD-SCT is indicated and, conversely, which patients do
not require transplantation for long-term disease control. A
matched-pair analysis was performed among patients treated according to
Acute Lymphoblastic Leukemia Relapse
Berlin-Frankfurt-Münster (ALL-REZ BFM) Study Group protocols after first relapse with chemotherapy or UD-SCT. Altogether 81 pairs
were identified that could be matched exactly for site of relapse and
immunophenotype, and as closely as possible for duration of first
remission, age, diagnosis date, and peripheral blast cell count at
relapse. No significant difference in the probability of event-free
survival (pEFS) between UD-SCT and chemotherapy existed regarding 28 pairs with an intermediate prognosis (0.39 ± 0.10 vs 0.49 ± 0.11,
P = .105), whereas the pEFS was significantly different
in the 53 pairs with a poor prognosis (0.44 ± 0.07 vs 0.00 ± 0.00, P < .001). The major reasons of
treatment failure among patients who underwent UD-SCT were
therapy-related death (TRD; 24/81) and relapses (20/81). In contrast,
TRD rarely occurred in patients treated with chemotherapy alone (3/81),
but relapse was much more common (62/81). In conclusion, UD-SCT
provides better event-free survival for children with high-risk
relapsed ALL. However, there is no clear advantage of UD-SCT in
patients with intermediate prognosis.
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