Most, but not all, doctors recommend treatment with allogeneic stem cell transplantation for children with acute lymphoblastic leukemia in second complete remission. Investigators from Memorial Sloan Kettering Cancer Center reported the results of a clinical study that compared allogeneic stem cell transplant to conventional chemotherapy treatment in children with acute lymphoblastic leukemia in second complete remission.
All patients participating in this clinical study were less than 18 years of age and had an HLA-matched sibling stem cell donor. At 5 years from initiation of treatment, 62% of patients treated with high-dose allogeneic stem cell transplantation were alive without cancer recurrence compared to only 26% of patients treated with conventional chemotherapy. The reason for the higher cure rate was mostly due to the ability of allogeneic stem cell transplantation to prevent cancer recurrence. Sixty-seven percent of patients treated with conventional chemotherapy experienced recurrence of leukemia compared to only 19% of patients treated with allogeneic stem cell transplant. Most importantly, all patients, regardless of risk factors, had superior outcome when treated with allogeneic stem cell transplantation. Patients who had failed initial treatment with chemotherapy regimens using more than 5 drugs or anthracyclines, patients with elevated white blood counts, and patients that took a prolonged time to achieve an initial clinical remission all were more likely to be cured with allogeneic stem cell transplantation than conventional chemotherapy.
In summary, high-dose chemotherapy and allogeneic stem cell transplantation from an HLA-matched sibling donor cures more patients with acute lymphoblastic leukemia in second complete remission than conventional chemotherapy. (Journal of Clinical Oncology, Vol 17, pp 197-207, 1999)