Treatment of childhood acute lymphoblastic leukemia in second remission with allogeneic bone marrow transplantation and chemotherapy: Ten-year experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association

Cornelio Uderzo, Maria Grazia Valsecchi, Andrea Bacigalupo, Giovanna Meloni, Chiara Messina, Paola Polchi, Gabriele Di Girolamo, Giorgio Dini, Roberto Miniero, Franco Locatelli, Roberto Colella, Paolo Tamaro, Margherita Lo Curto, Maria Teresa Di Tullio, Giuseppe Masera

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Abstract

Purpose: To compare the results of allogeneic bone marrow transplantation (AlloBMT) with those obtained with chemotherapy (CHEMO) in children with acute lymphoblastic leukemia (ALL) in second complete remission (CR) after a marrow relapse. The experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatrie Hematology Oncology Association is summarized. Patients and Methods: All children who had a relapse in the period 1980 to 1989 in 27 centers in Italy were eligible for the study. Of 287 eligible patients, 230 were treated with CHEMO, most of them (93%) according to a standard multiple-drug relapse protocol. The remaining 57 children underwent AlIoBMT. Preparative regimens included total-body irradiation and chemotherapy (n = 51) or chemotherapy alone (n = 6). Statistical analysis was performed with a Cox regression model adjusting for waiting time to transplant and prognostic factors. Results: In the whole series, minimum and median follow-up after second CR were 3 and 6.2 years, respectively; at 8 years from second CR, disease-free survival (DFS) was 20.0% (SE 2.5) and survival was 26.4% (SE 2.9). In the group of patients with an early first relapse, DFS was significantly longer after AIIoBMT than after CHEMO (relative risk [RR] = 0.45, P = .002). No significant advantage of AIIoBMT over CHEMO was found for patients with a late relapse (> 30 months since diagnosis). Duration of first CR significantly influenced prognosis in the CHEMO group (RR = 0.32, P = .0001 for patients with late first relapse versus patients with early first relapse). Conclusion: Results suggest an advantage in DFS of AIIoBMT over CHEMO in ALL patients who experienced an early first medullary relapse. Prospective trials are needed to address efficacy of AIIoBMT versus CHEMO in patients with late bone marrow relapse. J Clin Oncol 13:352-358.

Original languageEnglish
Pages (from-to)352-358
Number of pages7
JournalJournal of Clinical Oncology
Volume13
Issue number2
Publication statusPublished - Feb 1995

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Homologous Transplantation
Hematology
Bone Marrow Transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Recurrence
Drug Therapy
Disease-Free Survival
Therapeutics
Bone Marrow
Whole-Body Irradiation
Proportional Hazards Models
Italy
Transplants
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Treatment of childhood acute lymphoblastic leukemia in second remission with allogeneic bone marrow transplantation and chemotherapy : Ten-year experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association. / Uderzo, Cornelio; Valsecchi, Maria Grazia; Bacigalupo, Andrea; Meloni, Giovanna; Messina, Chiara; Polchi, Paola; Di Girolamo, Gabriele; Dini, Giorgio; Miniero, Roberto; Locatelli, Franco; Colella, Roberto; Tamaro, Paolo; Lo Curto, Margherita; Di Tullio, Maria Teresa; Masera, Giuseppe.

In: Journal of Clinical Oncology, Vol. 13, No. 2, 02.1995, p. 352-358.

Research output: Contribution to journalArticle

Uderzo, C, Valsecchi, MG, Bacigalupo, A, Meloni, G, Messina, C, Polchi, P, Di Girolamo, G, Dini, G, Miniero, R, Locatelli, F, Colella, R, Tamaro, P, Lo Curto, M, Di Tullio, MT & Masera, G 1995, 'Treatment of childhood acute lymphoblastic leukemia in second remission with allogeneic bone marrow transplantation and chemotherapy: Ten-year experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association', Journal of Clinical Oncology, vol. 13, no. 2, pp. 352-358.
Uderzo, Cornelio ; Valsecchi, Maria Grazia ; Bacigalupo, Andrea ; Meloni, Giovanna ; Messina, Chiara ; Polchi, Paola ; Di Girolamo, Gabriele ; Dini, Giorgio ; Miniero, Roberto ; Locatelli, Franco ; Colella, Roberto ; Tamaro, Paolo ; Lo Curto, Margherita ; Di Tullio, Maria Teresa ; Masera, Giuseppe. / Treatment of childhood acute lymphoblastic leukemia in second remission with allogeneic bone marrow transplantation and chemotherapy : Ten-year experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association. In: Journal of Clinical Oncology. 1995 ; Vol. 13, No. 2. pp. 352-358.
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title = "Treatment of childhood acute lymphoblastic leukemia in second remission with allogeneic bone marrow transplantation and chemotherapy: Ten-year experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association",
abstract = "Purpose: To compare the results of allogeneic bone marrow transplantation (AlloBMT) with those obtained with chemotherapy (CHEMO) in children with acute lymphoblastic leukemia (ALL) in second complete remission (CR) after a marrow relapse. The experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatrie Hematology Oncology Association is summarized. Patients and Methods: All children who had a relapse in the period 1980 to 1989 in 27 centers in Italy were eligible for the study. Of 287 eligible patients, 230 were treated with CHEMO, most of them (93{\%}) according to a standard multiple-drug relapse protocol. The remaining 57 children underwent AlIoBMT. Preparative regimens included total-body irradiation and chemotherapy (n = 51) or chemotherapy alone (n = 6). Statistical analysis was performed with a Cox regression model adjusting for waiting time to transplant and prognostic factors. Results: In the whole series, minimum and median follow-up after second CR were 3 and 6.2 years, respectively; at 8 years from second CR, disease-free survival (DFS) was 20.0{\%} (SE 2.5) and survival was 26.4{\%} (SE 2.9). In the group of patients with an early first relapse, DFS was significantly longer after AIIoBMT than after CHEMO (relative risk [RR] = 0.45, P = .002). No significant advantage of AIIoBMT over CHEMO was found for patients with a late relapse (> 30 months since diagnosis). Duration of first CR significantly influenced prognosis in the CHEMO group (RR = 0.32, P = .0001 for patients with late first relapse versus patients with early first relapse). Conclusion: Results suggest an advantage in DFS of AIIoBMT over CHEMO in ALL patients who experienced an early first medullary relapse. Prospective trials are needed to address efficacy of AIIoBMT versus CHEMO in patients with late bone marrow relapse. J Clin Oncol 13:352-358.",
author = "Cornelio Uderzo and Valsecchi, {Maria Grazia} and Andrea Bacigalupo and Giovanna Meloni and Chiara Messina and Paola Polchi and {Di Girolamo}, Gabriele and Giorgio Dini and Roberto Miniero and Franco Locatelli and Roberto Colella and Paolo Tamaro and {Lo Curto}, Margherita and {Di Tullio}, {Maria Teresa} and Giuseppe Masera",
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T1 - Treatment of childhood acute lymphoblastic leukemia in second remission with allogeneic bone marrow transplantation and chemotherapy

T2 - Ten-year experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatric Hematology Oncology Association

AU - Uderzo, Cornelio

AU - Valsecchi, Maria Grazia

AU - Bacigalupo, Andrea

AU - Meloni, Giovanna

AU - Messina, Chiara

AU - Polchi, Paola

AU - Di Girolamo, Gabriele

AU - Dini, Giorgio

AU - Miniero, Roberto

AU - Locatelli, Franco

AU - Colella, Roberto

AU - Tamaro, Paolo

AU - Lo Curto, Margherita

AU - Di Tullio, Maria Teresa

AU - Masera, Giuseppe

PY - 1995/2

Y1 - 1995/2

N2 - Purpose: To compare the results of allogeneic bone marrow transplantation (AlloBMT) with those obtained with chemotherapy (CHEMO) in children with acute lymphoblastic leukemia (ALL) in second complete remission (CR) after a marrow relapse. The experience of the Italian Bone Marrow Transplantation Group and the Italian Pediatrie Hematology Oncology Association is summarized. Patients and Methods: All children who had a relapse in the period 1980 to 1989 in 27 centers in Italy were eligible for the study. Of 287 eligible patients, 230 were treated with CHEMO, most of them (93%) according to a standard multiple-drug relapse protocol. The remaining 57 children underwent AlIoBMT. Preparative regimens included total-body irradiation and chemotherapy (n = 51) or chemotherapy alone (n = 6). Statistical analysis was performed with a Cox regression model adjusting for waiting time to transplant and prognostic factors. Results: In the whole series, minimum and median follow-up after second CR were 3 and 6.2 years, respectively; at 8 years from second CR, disease-free survival (DFS) was 20.0% (SE 2.5) and survival was 26.4% (SE 2.9). In the group of patients with an early first relapse, DFS was significantly longer after AIIoBMT than after CHEMO (relative risk [RR] = 0.45, P = .002). No significant advantage of AIIoBMT over CHEMO was found for patients with a late relapse (> 30 months since diagnosis). Duration of first CR significantly influenced prognosis in the CHEMO group (RR = 0.32, P = .0001 for patients with late first relapse versus patients with early first relapse). Conclusion: Results suggest an advantage in DFS of AIIoBMT over CHEMO in ALL patients who experienced an early first medullary relapse. Prospective trials are needed to address efficacy of AIIoBMT versus CHEMO in patients with late bone marrow relapse. J Clin Oncol 13:352-358.

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