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Stem Cell Transplant Bests Chemo for Common Childhood Leukemia

Five-year survival rates were better than with high-dose chemotherapy, study says

THURSDAY, Aug. 4, 2005 (HealthDayNews) -- The worst cases of acute lymphoblastic leukemia, the most common leukemia in children, respond better to a stem cell transplant than to chemotherapy, a new study finds.

High-risk acute lymphoblastic leukemia is characterized by various biological markers at onset or by resistance to treatment. Standard treatment is high-dose chemotherapy; in most cases the outcome is poor.

To determine whether stem cell transplantation was better than standard high-dose chemotherapy, Dr. Adriana Balduzzi, from the Universita' degli Studi di Milano Bicocca, Italy, and colleagues randomly selected children with acute lymphoblastic leukemia who received either standard chemotherapy or stem cell transplantation.

The report appears in the Aug. 4 early online issue of The Lancet.

Of the 357 children in the trial, 280 were given chemotherapy and 77 underwent stem cell transplantation from a compatible, related donor.

Balduzzi's team found that 41 percent of the children who received chemotherapy survived five years without recurrence of the disease, compared with 57 percent of the children who received stem cells. Moreover, 56 percent of the children who received stem cells were alive after five years, compared with 50 percent of the children who received chemotherapy.

"This international prospective study, based on treatment allocation by genetic chance, provided evidence that children with very high-risk acute lymphoblastic leukemia benefit from related donor hemopoietic-cell transplantation compared with chemotherapy, and showed that the gap between the two strategies increases as the risk profile of the patient worsens," the researchers concluded.

One expert believes that this study can be of great help to doctors in deciding how to treat children with acute lymphoblastic leukemia.

"These investigators should be commended," said Louis DeGennaro, vice president of research at the Leukemia & Lymphoma Society. "This is the first prospective study to demonstrate that children with extremely high-risk acute lymphoblastic leukemia benefit significantly from stem cell transplantation from related donors as opposed to standard chemotherapy."

"The value here is that these results provide physicians with important guidance in making difficult treatment decisions for this high-risk population," DeGennaro said.

Physicians are faced with having to choose between two difficult therapies, he noted.

"Chemotherapy is pretty toxic, and stem cell transplantation requires a regime of chemotherapy as well," he said. "These are difficult treatment decisions, and to date there hasn't been a study like this that clearly allows some guidance in terms of which of the two approaches is better."

More information

The American Cancer Society can tell you more about acute lymphoblastic leukemia.

SOURCES: Louis DeGennaro, Ph.D., vice president, research, Leukemia & Lymphoma Society, White Plains, N.Y.; Aug. 4, 2005, The Lancet online
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