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Blood, 1 June 2001, Vol. 97, No. 11, pp. 3672-3673
CORRESPONDENCE
To the editor:
Intensive chemotherapy and bone marrow transplantation for
children with acute myeloid leukemia
In a recent article, Woods et al detail the findings of a
well-designed Children's Cancer Group study comparing matched sibling allogeneic bone marrow transplantation (BMT), autologous bone marrow
transplantation, and intensive chemotherapy for children with acute
myeloid leukemia (AML) in first complete remission (CR).1
The authors drew 2 conclusions that are subject to debate. First,
referring to beneficial effect of intensively timed induction therapy,
they state that "for the first time in North America we have
demonstrated a therapeutic approach to children and adolescents with
AML that leads to cure half of the time, ... irrespective of the
presence of a ... family donor." 1(p61) It is true
that the presented event-free survival estimates for both the
allogeneic BMT and chemotherapy groups receiving intensively timed
induction therapy exceeded 50% (66% and 53%, respectively); this
statement is misleading, however, because this analysis includes only
children successfully completing induction therapy and in remission (652 of 887). As the authors themselves point out, the overall survival rate from diagnosis for all patients
(allogeneic BMT, autologous BMT, and chemotherapy only)
receiving intensively timed induction chemotherapy was only
49%. The authors, citing the superior overall survival rate for children
receiving matched related allogeneic BMT (allogeneic, 60%;
chemotherapy, 53%; autologous BMT, 48%), conclude that "for younger
patients, including children and adolescents, allogeneic BMT for AML in
first remission is the treatment of choice when a matched related donor
is available."1(p60-61) The authors imply that, for
pediatric patients with a matched related donor, a strategy employing
allogeneic transplantation in first remission is more effective than a
strategy reserving transplantation for the treatment of relapses. The
study's design does not permit such a conclusion to be drawn, since
all patients with a matched related donor were assigned to a transplant
in first remission. By definition, the only potential allogeneic transplant options available to patients in the other 2 groups in the
event of a relapse were alternative donor transplants. A randomized
controlled study comparing conventional chemotherapy with
allogeneic transplantation involving only subjects with
matched related donors would be necessary to definitively answer this question. Understandably, this would be much more difficult to conduct.
John Horan and Dave Korones
Correspondence: John Horan, Box 777, University of Rochester,
601 Elmwood Ave, Rochester, NY 14642
Reference
1.
Woods WG, Neudorf S, Gold S, et al.
A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive chemotherapy in children with acute myeloid leukemia in remission: a report from the Children's Cancer Group.
Blood.
2001;97:56-62[Abstract/Free Full Text].
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Related Article in Blood Online:
-
A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive chemotherapy in children with acute myeloid leukemia in remission: a report from the Children's Cancer Group
- William G. Woods, Steven Neudorf, Stuart Gold, Jean Sanders, Jonathan D. Buckley, Dorothy R. Barnard, Kathryn Dusenbery, Joetta DeSwarte, Diane C. Arthur, Beverly J. Lange, and Nathan L. Kobrinsky
Blood 2001 97: 56-62.
[Abstract]
[Full Text]
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