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.
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. O...
| 主要な著者: | , , , , , , |
|---|---|
| フォーマット: | Journal article |
| 言語: | English |
| 出版事項: |
2000
|
| _version_ | 1826278986806722560 |
|---|---|
| author | Wheeler, K Richards, S Bailey, C Gibson, B Hann, I Hill, F Chessells, J |
| author_facet | Wheeler, K Richards, S Bailey, C Gibson, B Hann, I Hill, F Chessells, J |
| author_sort | Wheeler, K |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-06T23:52:06Z |
| format | Journal article |
| id | oxford-uuid:72f2dbf3-2dab-4ba7-b7f8-5f37bcb1208c |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:52:06Z |
| publishDate | 2000 |
| record_format | dspace |
| spelling | oxford-uuid:72f2dbf3-2dab-4ba7-b7f8-5f37bcb1208c2022-03-26T19:53:23ZBone 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.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:72f2dbf3-2dab-4ba7-b7f8-5f37bcb1208cEnglishSymplectic Elements at Oxford2000Wheeler, KRichards, SBailey, CGibson, BHann, IHill, FChessells, JThe 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. |
| spellingShingle | Wheeler, K Richards, S Bailey, C Gibson, B Hann, I Hill, F Chessells, J 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. |
| title | 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. |
| title_full | 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. |
| title_fullStr | 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. |
| title_full_unstemmed | 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. |
| title_short | 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. |
| title_sort | 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 |
| work_keys_str_mv | AT wheelerk bonemarrowtransplantationversuschemotherapyinthetreatmentofveryhighriskchildhoodacutelymphoblasticleukemiainfirstremissionresultsfrommedicalresearchcouncilukallxandxi AT richardss bonemarrowtransplantationversuschemotherapyinthetreatmentofveryhighriskchildhoodacutelymphoblasticleukemiainfirstremissionresultsfrommedicalresearchcouncilukallxandxi AT baileyc bonemarrowtransplantationversuschemotherapyinthetreatmentofveryhighriskchildhoodacutelymphoblasticleukemiainfirstremissionresultsfrommedicalresearchcouncilukallxandxi AT gibsonb bonemarrowtransplantationversuschemotherapyinthetreatmentofveryhighriskchildhoodacutelymphoblasticleukemiainfirstremissionresultsfrommedicalresearchcouncilukallxandxi AT hanni bonemarrowtransplantationversuschemotherapyinthetreatmentofveryhighriskchildhoodacutelymphoblasticleukemiainfirstremissionresultsfrommedicalresearchcouncilukallxandxi AT hillf bonemarrowtransplantationversuschemotherapyinthetreatmentofveryhighriskchildhoodacutelymphoblasticleukemiainfirstremissionresultsfrommedicalresearchcouncilukallxandxi AT chessellsj bonemarrowtransplantationversuschemotherapyinthetreatmentofveryhighriskchildhoodacutelymphoblasticleukemiainfirstremissionresultsfrommedicalresearchcouncilukallxandxi |