[Intensification chemotherapy followed by allogenieic and autologous bone marrow transplantation in acute non-lymphoblastic leukemia in children].

UNLABELLED

Both intensification therapies with high-doses ARA-C and bone marrow transplant, allogeneic (BMT) or autologous (ABMT), have proved effective in relapse prevention in ANLL. The present study combines both treatments. METHODS. Remission induction treatment was DAE combination. The first intensification consisted of HD ARA-C and mitoxantrone and the second HD ARA-C and AMSA. CNS prophylaxis consisted of 6 doses of i.t. ARA-C and MTX. Later, patients in remission with HLA-compatible donor received BMT and those without it, ABMT with "ex vivo" treatment of the bone marrow with ASTA-Z. Pre-BMT treatment was the same in both cases: fractionated total body irradiation (TBI) and cyclophosphamide in patients over 3 years of age; in patients under 3 busulfan was given instead of TBI. PATIENTS. Between April 88 and March 90, 18 patients (age 3 months to 14 years) were included. FAB subtypes were M1 + M2: 4; M3: 2; M4: 4; M5: 5; M6: 1; M7: 2. Two patients died of cranial haemorrhage before the 10th day, 15 achieved complete remission (CR) after one or two induction treatments and 1 only attained CR after the first intensification.

RESULTS

1 patient with M7 relapsed after the 2nd intensification. Of the remaining 15, five received BMT and ten ABMT. Average interval between CR and transplant was 4 months (3 to 8). Of the 5 with BMT, one died from progressive obliterating bronchiolitis at 9 months and the other four continued in CR for 6 to 28 months. Of the 10 with ABMT none died from complications, 2 suffered early relapse and 8 continued in CR for 6 to 28 months.(ABSTRACT TRUNCATED AT 250 WORDS)