Children with very high-risk acute lymphoblastic leukaemia ( ALL ) benefit if they receive a blood stem cell transplant from a compatible related donor rather than chemotherapy.

ALL is the main type of leukaemia affecting children. High-risk childhood ALL is defined by various biological characteristics at onset or by resistance to treatment. High dose chemotherapy is the standard treatment for children with high-risk ALL but in most cases the prognosis is poor.

Adriana Balduzzi at Universita' degli Studi di Milano Bicocca, Italy, and colleagues did a randomised trial to compare chemotherapy with transplantation in patients in first complete remission—when there is no sign of the cancer on the patient’s medical scans.

Between 1995 and 2000 the investigators recruited patients younger than 18 years with newly diagnosed ALL onto the study.
Centres from seven countries took part in the study.

A total of 357 children entered the study, 280 were assigned chemotherapy and 77 were assigned to blood stem cell transplant on the basis that there was an available compatible related donor.

The researchers found that the 5-year disease-free survival was 41% in the chemotherapy group and 57% in the blood stem cell transplant group. 5-year survival was 50% for the chemotherapy group and 56% for the transplant group.

“ This international study has shown that availability of a compatible related donor for children with very-high risk acute lymphoblastic leukaemia in first complete remission improves disease-free survival;....the gap between the two strategies increased as the risk profile of the patient worsened, “ Balduzzi says.

Source: The Lancet, 2005


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