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Acute Lymphoblastic Leukaemia

Autologous bone marrow transplantation for childhood acute lymphoblastic leukemia: a novel combined approach consisting of ex vivo marrow purging, modulation of multi-drug resistance, induction of autograft vs leukemia effect, and post-transplant immuno- and chemotherapy (PTIC)

Bone Marrow Transplantation volume 27, pages 145–153 (2001)Cite this article

Abstract

In an attempt to reduce the high relapse rate associated with ABMT, five children with high-risk first CR and 19 in second or subsequent CR lacking matched family allogeneic donors underwent ABMT with chemopurged bone marrow utilizing verapamil (VPL), vincristine, and VP-16. Patients were conditioned with TBI, VPL bolus and infusion with VP-16 and cyclophosphamide. The first cohort of patients (n = 4) received only cyclosporin A (CsA). The second cohort (n = 7) received CsA and alpha interferon (total = 11 with post-transplant immunotherapy alone.) The third cohort (n = 13) received CsA and six alternating cycles of αIFN and chemotherapy and six additional cycles of chemotherapy (vincristine, VP-16, Ara-C, prednisone) followed by G-CSF (post-transplant immune chemotherapy (PTIC)). The 2-year DFS is 42 ± 10% (90% confidence interval (CI) is 26.5–58.5%) and 2-year overall survival is 54 ± 10% (90% CI is 37.5–70.5%). Furthermore, patients receiving PTIC (n = 13) vsimmunotherapy alone (CsA ± αIFN) (n = 11) had a substantially better 2 year DFS and OS: 69 ± 13% vs 13 ± 12% and 85 ± 10% vs 25 ± 15% (P = 0.008 and P = 0.06, respectively). These results suggest that the use of ABMT with chemopurging, combined with PTIC is well tolerated and may be an alternative new approach in the treatment of a subset of children with high-risk first CR or ⩾ second CR ALL who lack closely matched family-related allogeneic donors. Bone Marrow Transplantation (2001) 27, 145–153.

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Acknowledgements

We would like to thank Lisa Bozenhard-Froncek and Shaunta Evans for secretarial assistance and Linda Rahl for her editorial support. We would also like to thank Dr Leonard Sender for his review and suggestions for this manuscript. We would also like to thank Roche Pharmaceuticals for kindly providing Roferon. This work was supported by grants from the Pediatric Cancer Research Foundation, The Walden W and Jean Young Shaw Foundation, and the Elsa U Pardee Foundation.

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Author notes

  1. I Houtenbos and F Bracho: Houtenbos and Bracho contributed equally to this manuscript and should be considered both first and primary authors

Authors and Affiliations

  1. Division of Pediatric Oncology and Blood and Marrow Transplantation, Babies and Children's Hospital, Columbia University, New York, NY, USA

    I Houtenbos, V Davenport, C van de Ven & MS Cairo

  2. Department of Pediatrics and Biostatistics, Lombardi Cancer Center, Georgetown University, Washington, DC, USA

    F Bracho & R Slack

  3. Nexell Therapeutics Inc., Irvine, CA, USA

    Y Suen

  4. Children's Hospital Los Angeles, Los Angeles, CA, USA

    R Killen

  5. Children's Hospital of Orange County, Orange, CA, USA

    V Shen

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Houtenbos, I., Bracho, F., Davenport, V. et al. Autologous bone marrow transplantation for childhood acute lymphoblastic leukemia: a novel combined approach consisting of ex vivo marrow purging, modulation of multi-drug resistance, induction of autograft vs leukemia effect, and post-transplant immuno- and chemotherapy (PTIC). Bone Marrow Transplant 27, 145–153 (2001). https://doi.org/10.1038/sj.bmt.1702750

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