Early HDC Improves Survival in Infants With Acute Leukemia

SANTANDER, Spain—High-dose chemotherapy (HDC) with stem cell transplantation offers a “striking improvement” over conventional chemotherapy for infants with acute leukemia, said Fernando Marco, MD, a hematologist at Hospital Universitario Marques de Valdecilla, Santander, Spain.

In this study, 26 infants with acute leukemia underwent high-dose chemotherapy with stem cell transplantation (eight allogeneic and 18 autologous). Fifteen patients had acute myeloid leukemia, 10 had acute lymphoid leukemia, and one had a bilineal leukemia.

All patients had been previously treated: 22 were in their first complete remission, three were in their second complete remission, and one was in relapse.

At 67 months median follow-up, the 5-year overall survival rate is 64% and the 5-year disease-free survival rate is 63%. Outcomes were similar with use of allogeneic and autologous transplantation (J Clin Oncol 18:3256-3261, 2000).

No Transplant-Related Deaths

Dr. Marco reported that there was no transplant-related mortality; all deaths were due to relapse in the first 6 months after transplantation. In multivariate analysis, he said, the single factor associated with better disease-free survival was an interval between first complete remission and transplantation of less than 4 months (P < .025).

“Stem cell transplantation is a valid option in the treatment of infant acute leukemia,” Dr. Marco concluded, “and it may overcome the high risk of relapse with conventional chemotherapy. The study suggests that stem cell transplantation should be performed when the patient is in first complete remission.”