Bone marrow transplants from HLA-identical siblings as compared with chemotherapy for children with acute lymphoblastic leukemia in a second remission

A. John Barrett, Mary M. Horowitz, Bradley H Pollock, Mei Jie Zhang, Mortimer M. Bortin, George R. Buchanan, Bruce M. Camitta, Judith Ochs, John Graham-Pole, Philip A. Rowlings, Alfred A. Rimm, John P. Klein, Jonathan J. Shuster, Kathleen A. Sobocinski, Robert Peter Gale

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Abstract

Background. It is unclear how best to treat children with acute lymphoblastic leukemia who are in a second remission after a bone marrow relapse. For those with HLA-identical siblings, the question of whether to perform a bone marrow transplantation or to continue chemotherapy has not been answered. Methods. We compared the results of treatment with marrow transplants from HLA-identical siblings in 376 children, as reported to the International Bone Marrow Transplant Registry, with the results of chemotherapy in 540 children treated by the Pediatric Oncology Group. A preliminary analysis identified variables associated with treatment failure in both groups. We selected cohorts by matching these variables. A possible bias associated with differences in the interval between remission and treatment was controlled for by choosing matched pairs in which the duration of the second remission in the chemotherapy recipient was at least as long as the time between the second remission and transplantation in the transplant recipient. A total of 255 matched pairs were studied. Results. The mean (±SE) probability of a relapse at five years was significantly lower among the transplant recipients than among the chemotherapy recipients (45±4 percent vs. 80±3 percent, P<0.001). At five years the probability of leukemia-free survival was higher after transplantation than after chemotherapy (40±3 percent vs. 17±3 percent, P<0.001). The relative benefit of transplantation as compared with chemotherapy was similar in children with prognostic factors indicating a high or low risk of relapse (the duration of the first remission, age, leukocyte count at the time of the diagnosis, and phenotype of the leukemic cells). Conclusions. For children with acute lymphoblastic leukemia in a second remission, bone marrow transplants from HLA-identical siblings result in fewer relapses and longer leukemia-free survival than does chemotherapy.

Original languageEnglish (US)
Pages (from-to)1253-1258
Number of pages6
JournalNew England Journal of Medicine
Volume331
Issue number19
DOIs
StatePublished - Nov 10 1994
Externally publishedYes

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Siblings
Bone Marrow
Transplants
Drug Therapy
Recurrence
Transplantation
Leukemia
Survival
Treatment Failure
Bone Marrow Transplantation
Leukocyte Count
Registries
Pediatrics
Phenotype
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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Bone marrow transplants from HLA-identical siblings as compared with chemotherapy for children with acute lymphoblastic leukemia in a second remission. / Barrett, A. John; Horowitz, Mary M.; Pollock, Bradley H; Zhang, Mei Jie; Bortin, Mortimer M.; Buchanan, George R.; Camitta, Bruce M.; Ochs, Judith; Graham-Pole, John; Rowlings, Philip A.; Rimm, Alfred A.; Klein, John P.; Shuster, Jonathan J.; Sobocinski, Kathleen A.; Gale, Robert Peter.

In: New England Journal of Medicine, Vol. 331, No. 19, 10.11.1994, p. 1253-1258.

Research output: Contribution to journalArticle

Barrett, AJ, Horowitz, MM, Pollock, BH, Zhang, MJ, Bortin, MM, Buchanan, GR, Camitta, BM, Ochs, J, Graham-Pole, J, Rowlings, PA, Rimm, AA, Klein, JP, Shuster, JJ, Sobocinski, KA & Gale, RP 1994, 'Bone marrow transplants from HLA-identical siblings as compared with chemotherapy for children with acute lymphoblastic leukemia in a second remission', New England Journal of Medicine, vol. 331, no. 19, pp. 1253-1258. https://doi.org/10.1056/NEJM199411103311902
Barrett, A. John ; Horowitz, Mary M. ; Pollock, Bradley H ; Zhang, Mei Jie ; Bortin, Mortimer M. ; Buchanan, George R. ; Camitta, Bruce M. ; Ochs, Judith ; Graham-Pole, John ; Rowlings, Philip A. ; Rimm, Alfred A. ; Klein, John P. ; Shuster, Jonathan J. ; Sobocinski, Kathleen A. ; Gale, Robert Peter. / Bone marrow transplants from HLA-identical siblings as compared with chemotherapy for children with acute lymphoblastic leukemia in a second remission. In: New England Journal of Medicine. 1994 ; Vol. 331, No. 19. pp. 1253-1258.
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title = "Bone marrow transplants from HLA-identical siblings as compared with chemotherapy for children with acute lymphoblastic leukemia in a second remission",
abstract = "Background. It is unclear how best to treat children with acute lymphoblastic leukemia who are in a second remission after a bone marrow relapse. For those with HLA-identical siblings, the question of whether to perform a bone marrow transplantation or to continue chemotherapy has not been answered. Methods. We compared the results of treatment with marrow transplants from HLA-identical siblings in 376 children, as reported to the International Bone Marrow Transplant Registry, with the results of chemotherapy in 540 children treated by the Pediatric Oncology Group. A preliminary analysis identified variables associated with treatment failure in both groups. We selected cohorts by matching these variables. A possible bias associated with differences in the interval between remission and treatment was controlled for by choosing matched pairs in which the duration of the second remission in the chemotherapy recipient was at least as long as the time between the second remission and transplantation in the transplant recipient. A total of 255 matched pairs were studied. Results. The mean (±SE) probability of a relapse at five years was significantly lower among the transplant recipients than among the chemotherapy recipients (45±4 percent vs. 80±3 percent, P<0.001). At five years the probability of leukemia-free survival was higher after transplantation than after chemotherapy (40±3 percent vs. 17±3 percent, P<0.001). The relative benefit of transplantation as compared with chemotherapy was similar in children with prognostic factors indicating a high or low risk of relapse (the duration of the first remission, age, leukocyte count at the time of the diagnosis, and phenotype of the leukemic cells). Conclusions. For children with acute lymphoblastic leukemia in a second remission, bone marrow transplants from HLA-identical siblings result in fewer relapses and longer leukemia-free survival than does chemotherapy.",
author = "Barrett, {A. John} and Horowitz, {Mary M.} and Pollock, {Bradley H} and Zhang, {Mei Jie} and Bortin, {Mortimer M.} and Buchanan, {George R.} and Camitta, {Bruce M.} and Judith Ochs and John Graham-Pole and Rowlings, {Philip A.} and Rimm, {Alfred A.} and Klein, {John P.} and Shuster, {Jonathan J.} and Sobocinski, {Kathleen A.} and Gale, {Robert Peter}",
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T1 - Bone marrow transplants from HLA-identical siblings as compared with chemotherapy for children with acute lymphoblastic leukemia in a second remission

AU - Barrett, A. John

AU - Horowitz, Mary M.

AU - Pollock, Bradley H

AU - Zhang, Mei Jie

AU - Bortin, Mortimer M.

AU - Buchanan, George R.

AU - Camitta, Bruce M.

AU - Ochs, Judith

AU - Graham-Pole, John

AU - Rowlings, Philip A.

AU - Rimm, Alfred A.

AU - Klein, John P.

AU - Shuster, Jonathan J.

AU - Sobocinski, Kathleen A.

AU - Gale, Robert Peter

PY - 1994/11/10

Y1 - 1994/11/10

N2 - Background. It is unclear how best to treat children with acute lymphoblastic leukemia who are in a second remission after a bone marrow relapse. For those with HLA-identical siblings, the question of whether to perform a bone marrow transplantation or to continue chemotherapy has not been answered. Methods. We compared the results of treatment with marrow transplants from HLA-identical siblings in 376 children, as reported to the International Bone Marrow Transplant Registry, with the results of chemotherapy in 540 children treated by the Pediatric Oncology Group. A preliminary analysis identified variables associated with treatment failure in both groups. We selected cohorts by matching these variables. A possible bias associated with differences in the interval between remission and treatment was controlled for by choosing matched pairs in which the duration of the second remission in the chemotherapy recipient was at least as long as the time between the second remission and transplantation in the transplant recipient. A total of 255 matched pairs were studied. Results. The mean (±SE) probability of a relapse at five years was significantly lower among the transplant recipients than among the chemotherapy recipients (45±4 percent vs. 80±3 percent, P<0.001). At five years the probability of leukemia-free survival was higher after transplantation than after chemotherapy (40±3 percent vs. 17±3 percent, P<0.001). The relative benefit of transplantation as compared with chemotherapy was similar in children with prognostic factors indicating a high or low risk of relapse (the duration of the first remission, age, leukocyte count at the time of the diagnosis, and phenotype of the leukemic cells). Conclusions. For children with acute lymphoblastic leukemia in a second remission, bone marrow transplants from HLA-identical siblings result in fewer relapses and longer leukemia-free survival than does chemotherapy.

AB - Background. It is unclear how best to treat children with acute lymphoblastic leukemia who are in a second remission after a bone marrow relapse. For those with HLA-identical siblings, the question of whether to perform a bone marrow transplantation or to continue chemotherapy has not been answered. Methods. We compared the results of treatment with marrow transplants from HLA-identical siblings in 376 children, as reported to the International Bone Marrow Transplant Registry, with the results of chemotherapy in 540 children treated by the Pediatric Oncology Group. A preliminary analysis identified variables associated with treatment failure in both groups. We selected cohorts by matching these variables. A possible bias associated with differences in the interval between remission and treatment was controlled for by choosing matched pairs in which the duration of the second remission in the chemotherapy recipient was at least as long as the time between the second remission and transplantation in the transplant recipient. A total of 255 matched pairs were studied. Results. The mean (±SE) probability of a relapse at five years was significantly lower among the transplant recipients than among the chemotherapy recipients (45±4 percent vs. 80±3 percent, P<0.001). At five years the probability of leukemia-free survival was higher after transplantation than after chemotherapy (40±3 percent vs. 17±3 percent, P<0.001). The relative benefit of transplantation as compared with chemotherapy was similar in children with prognostic factors indicating a high or low risk of relapse (the duration of the first remission, age, leukocyte count at the time of the diagnosis, and phenotype of the leukemic cells). Conclusions. For children with acute lymphoblastic leukemia in a second remission, bone marrow transplants from HLA-identical siblings result in fewer relapses and longer leukemia-free survival than does chemotherapy.

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U2 - 10.1056/NEJM199411103311902

DO - 10.1056/NEJM199411103311902

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