PMID- 9324340
OWN - NLM
STAT- MEDLINE
DCOM- 19971015
LR  - 20190905
IS  - 0098-1532 (Print)
IS  - 0098-1532 (Linking)
VI  - 29
IP  - 6
DP  - 1997 Dec
TI  - Bone marrow transplantation versus chemotherapy for maintenance of second 
      remission of childhood acute lymphoblastic leukemia: a study of the Children's 
      Cancer Group (CCG-1884).
PG  - 534-40
AB  - BACKGROUND: Maintenance of second remission of childhood acute lymphoblastic 
      leukemia (ALL) with intensive chemotherapy is often unsuccessful. The major cause 
      of treatment failure is relapse. MATERIALS AND METHODS: Of 96 children with ALL 
      who relapsed in the marrow while on or within 1 year of completing initial 
      therapy, 62 achieved a second remission. Nineteen patients underwent bone marrow 
      transplantation in second remission, 11 from a human leukocyte antigen 
      (HLA)-matched related donor, seven using autologous marrow, and one from a 
      matched unrelated donor. The event-free survival (EFS) of transplanted patients 
      was compared to that of patients treated with intensive chemotherapy using 
      high-dose cytarabine, vincristine, escalating dose methotrexate, L-asparaginase, 
      and an anthracycline (daunorubicin or idarubicin). Only those patients treated 
      with chemotherapy who survived in second remission up to the mean time that 
      patients were transplanted (135 days) were included in the control group (33 of 
      43 patients who achieved second remission). RESULTS: The actuarial 2-year 
      event-free survival of transplanted patients is 37+/-22% (95% C.I.) compared to 
      18+/-13% for chemotherapy-treated patients (P=0.017). EFS for allo-transplant 
      recipients was similar to that for auto-transplant recipients. Duration of 
      initial remission was a strong predictor of the outcome of retrieval therapy. 
      Patients whose initial remission was greater than 3 years had better EFS after 
      achieving second remission (five of 11 still in remission, compared to four of 41 
      patients whose initial remission was less than 3 years). Adjustment in the 
      multivariate analysis for duration of initial remission did not diminish the 
      benefit of transplant over chemotherapy. CONCLUSIONS: While there remains 
      considerable possibility for further improvement in EFS after achieving second 
      remission of childhood ALL, bone marrow transplant is superior to chemotherapy in 
      maintaining second remission.
FAU - Feig, S A
AU  - Feig SA
AD  - UCLA Children's Hospital, Los Angeles, CA, USA.
FAU - Harris, R E
AU  - Harris RE
FAU - Sather, H N
AU  - Sather HN
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Med Pediatr Oncol
JT  - Medical and pediatric oncology
JID - 7506654
SB  - IM
MH  - Adolescent
MH  - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
MH  - *Bone Marrow Transplantation
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Male
MH  - Multivariate Analysis
MH  - Neoplasm Recurrence, Local/*therapy
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/*therapy
MH  - Proportional Hazards Models
MH  - Remission Induction
MH  - Survival Analysis
EDAT- 1997/10/23 22:17
MHDA- 2000/06/20 09:00
CRDT- 1997/10/23 22:17
PHST- 1997/10/23 22:17 [pubmed]
PHST- 2000/06/20 09:00 [medline]
PHST- 1997/10/23 22:17 [entrez]
AID - 10.1002/(SICI)1096-911X(199712)29:6<534::AID-MPO3>3.0.CO;2-L [pii]
AID - 10.1002/(sici)1096-911x(199712)29:6<534::aid-mpo3>3.0.co;2-l [doi]
PST - ppublish
SO  - Med Pediatr Oncol. 1997 Dec;29(6):534-40. doi: 
      10.1002/(sici)1096-911x(199712)29:6<534::aid-mpo3>3.0.co;2-l.