PMID- 11001892
OWN - NLM
STAT- MEDLINE
DCOM- 20001025
LR  - 20210216
IS  - 0006-4971 (Print)
IS  - 0006-4971 (Linking)
VI  - 96
IP  - 7
DP  - 2000 Oct 1
TI  - Bone marrow transplantation versus chemotherapy in the treatment of very 
      high-risk childhood acute lymphoblastic leukemia in first remission: results from 
      Medical Research Council UKALL X and XI.
PG  - 2412-8
AB  - The role of bone marrow transplantation (BMT) in first remission of children with 
      high-risk acute lymphoblastic leukemia (ALL) remains unclear. There were 3676 
      patients (aged 1 to 15 years) entered into the United Kingdom (UK) Medical 
      Research Council (MRC) trials UKALL X and XI from 1985 to 1997. Of these 
      patients, 473 patients (13%) were classified as very high (VH) risk and were 
      eligible for a transplantation from a matched histocompatible sibling donor 
      (MSD). We tissue-typed 286 patients; 99 patients had a matched related donor, and 
      76 patients received transplantations. Additionally, 25 children received 
      transplantations from a matched unrelated donor (MUD) despite trial guidelines 
      for MSD transplantations only. The median time to transplantation was 5 months 
      (range, 2 to 19 months), and the median follow-up was 8 years. The 10-year 
      event-free survival (EFS) adjusted for the time to transplantation, diagnostic 
      white blood cell (WBC) count, Ph chromosome status, and ploidy was 6. 0% higher 
      (95% confidence interval (CI), -10.5% to 22.5%) for 101 patients who received a 
      first-remission transplantation (MSD and MUD) than for the 351 patients treated 
      with chemotherapy (transplantation, 45.3%, vs chemotherapy, 39.3%). The 
      transplantation group had fewer relapses (31%) compared to relapses in the 
      chemotherapy group (55%); however, the transplantation group had more remission 
      deaths (18%) compared to remission deaths in the chemotherapy group (3%). In 
      contrast the adjusted 10-year EFS was 10. 7% higher (95% CI, -2.6% to 24.0%) for 
      patients without a human leukocyte antigen (HLA)-matched donor than for those 
      patients with a donor (no donor, 50.4%, vs donor, 39.7%). In conclusion, for the 
      majority of children with VH-risk ALL, the first-remission transplantation has 
      not improved EFS.
FAU - Wheeler, K A
AU  - Wheeler KA
AD  - John Radcliffe Hospital, Headington, Oxford, England. 
      kate.wheeler@paediatrics.oxford.ac.uk
FAU - Richards, S M
AU  - Richards SM
FAU - Bailey, C C
AU  - Bailey CC
FAU - Gibson, B
AU  - Gibson B
FAU - Hann, I M
AU  - Hann IM
FAU - Hill, F G
AU  - Hill FG
FAU - Chessells, J M
AU  - Chessells JM
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
SB  - IM
MH  - Adolescent
MH  - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
MH  - *Bone Marrow Transplantation
MH  - Child
MH  - Child, Preschool
MH  - Disease-Free Survival
MH  - Histocompatibility Testing
MH  - Humans
MH  - Infant
MH  - Leukocyte Count
MH  - Philadelphia Chromosome
MH  - Ploidies
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy/mortality/*surgery
MH  - Recurrence
MH  - Remission Induction
MH  - Risk Factors
MH  - United Kingdom
EDAT- 2000/09/26 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/09/26 11:00
PHST- 2000/09/26 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/09/26 11:00 [entrez]
AID - S0006-4971(20)54349-8 [pii]
PST - ppublish
SO  - Blood. 2000 Oct 1;96(7):2412-8.