Autologous Bone Marrow Transplantation - Blog Science Connections

92 ABMT in CR2 Pediatric ALL
first relapse. These studies showed a survival advantage for children undergoing
allogeneic bone marrow transplantation. For children who relapsed off therapy,
the results of allogeneic bone marrow transplantation and ABMT were
satisfactory; the authors (8,9) found that TBI may be fractionated and the total
dose increased to 12 Gy without major toxicities when TBI is associated with
cyclophosphamide administration alone.
For children who relapsed while in therapy, the relapse rate after
transplantation was high. It will be necessary to increase dosages of the
conditioning regimen, adding another chemotherapeutic agent such as highdose
cytarabine or melphalan.
The clinical results of ABMT in ALL of childhood should be evaluated
according to the course of the disease—whether relapse occurs during or after
therapy. We still do not know whether chemical agents such as mafosfamide
and VP-16-213 (etoposide), MAbs such as CD10 plus CD19 or a pan-T MAb
cocktail provide the best methods of cleansing bone marrow (10). The best way
to cleanse marrow cells might be to combine chemoseparation and immunoseparation
(paper submitted for publication).
Our results seem to favor ABMT during second remission, but prospective,
controlled trials must be done before any conclusion can be reached.
REFERENCES
1. Chessels JM. Semin Hematol 1985:19:155.
2. Miller DR, Leikin S, Albo V, Sather H, Karon M, Hammond D. Cancer 1983:51:1041.
3. Bleyer WA, Sather H, Hammond QD. Cancer 1986:58:590.
4. Rivera GK, Buchanan G, Boyett JM, Camitta B, Ochs J, Kalwinsky D, Amylon M, Vietti TJ, Crist
WM. N Engl J Med 1986;315:273.
5. Plouvier E, Hervé P, Noir A, Flesch M, Cahn JY, Racadot E, Henon P, Lutz P, Boilletot A, Behar C,
Munzer M, Raffi A. Arch Fr Pediatr 1985:42:4290.
6. Ramsay M, LeBien T, Nesbit M, McGlave P, Weisdorf D, Kenyon P, Hurd D, Goldman A, Kim T,
Kersey J. Blood 1985:66:508.
7. Takvorian T, Sallan S, Ritz J. In Minimal Residual Disease in Acute Leukemia 1986. Hagenbeek
A, Lowenberg B, eds. Martinus Nijhoff, Boston 1986:266.
8. Storb R. Exp Hematol 1985(Suppl 17);13:6.
9. Bacigalupo A, van Lint MT, Frassoni F, Occhini D, Pittaluga PA, Comelli A, Dini G, Massimo L,
Marmont AM. Bone Marrow Transplantation 1986:1:75.
10. Herve P. Plasma Therapy and Transfusion Technology 1985:6:359.