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The use of bone marrow transplantation as a therapeutic approach for ALL patients who have suffered a bone marrow relapse has increased in recent years. This approach involves the administration of intensive cytoreductive therapy, usually employing total body irradiation and high-dose chemotherapy in doses lethal to normal bone marrow and subsequent hematopoietic "rescue" with intravenously infused bone marrow obtained from a compatible donor. To some degree, the initial interest in bone marrow transplantation.
Continual innovation and technological refinements have given bone marrow transplantation a significant role in the treatment of childhood ALL. Currently, allogeneic marrow transplantation is routinely advocated, particularly for patients in second remission who have an appropriate donor. In this group of patients, overall disease-free survivals range from approximately 40% to more than 60%.
Better results are obtained in patients transplanted in remission than in those in relapse or partial remission. In most studies patients transplanted in earlier remissions fare significantly better than patients transplanted after multiple relapses. The length of first remission and high-risk features at diagnosis are predictive factors. Patients with shorter initial remissions and those with high-risk features at diagnosis fare worse when transplanted in second remission. Most studies that have compared the efficacy of allogeneic marrow transplantation with chemotherapy for patients who had experienced a previous relapse indicate that transplantation is associated with a superior outcome. Marrow transplantation appears to be particularly advantageous for patients who fare less well on their initial chemotherapy regimens.
A retrospective analysis performed by the International Bone Marrow Transplant Registry (IBMTR) compared marrow transplantation with chemotherapy for children with ALL in second remission.