Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 1042-1043 (doi:10.1542/peds.2007-0554)
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LETTER TO THE EDITOR

Autologous Cord Blood Transplantation in a Child With Acute Lymphoblastic Leukemia and Central Nervous System Relapse

Christian Urban, MD
Wolfgang Schwinger, MD
Martin Benesch, MD
Petra Sovinz, MD
Division of Pediatric Hematology and Oncology
Department of Pediatrics and Adolescent Medicine
Medical University of Graz
A-8036 Graz, Austria

Guenter Henze, MD
Division of Pediatric Hematology and Oncology
Department of Pediatrics
Charité Campus Virchow Klinikum
13353 Berlin, Germany

Hildegard Greinix, MD
Department of Internal Medicine I/BMT
Medical University of Vienna
A-1010 Vienna, Austria

To the Editor.—

We read with great interest "First Report of Autologous Cord Blood Transplantation in the Treatment of a Child With Leukemia" by Hayani et al.1 The authors reported on the first successful autologous cord blood transplantation in a child with acute lymphoblastic leukemia of the B-precursor subtype with isolated central nervous system (CNS) relapse within 10 months from diagnosis. However, CNS and total-body irradiation (TBI) combined with high-dose conditioning and autologous stem cell transplantation can be considered an overtreatment in a 3-year-old child with acute lymphoblastic leukemia and CNS relapse occurring within 18 months after initial diagnosis, because event-free survival is not superior in these patients compared with patients who are treated less intensively.2,3 It is well known that umbilical cord blood (UCB) is associated with higher rates of engraftment failure compared with peripheral blood stem cells, which could have been used as well assuming that both sources are equally effective. Because TBI is myeloablative and UCB neither provides the opportunity to boost delayed engraftment nor to harvest stem cells for a second time in case of graft failure, at least autologous peripheral blood stem cells should have been harvested as a backup in case of nonengraftment of the UCB. In addition, the long-term adverse effects of TBI such as infertility, growth retardation, and an increased risk of secondary neoplasms should have been kept in mind. We consider it a severe conflict of interest that one of the authors employed at the commercial UCB bank where the autologous cord blood was stored advertises this case report on the company's homepage as proof of principle for treating relapsed leukemia. Furthermore, this case report is now being advertised uncritically in many other private UCB banks worldwide.

REFERENCES

  1. Hayani A, Lampeter E, Viswanatha D, Morgan D, Salvi SN. First report of autologous cord blood transplantation in the treatment of a child with leukemia. Pediatrics. 2007;119 (1). Available at: www.pediatrics.org/cgi/content/full/119/1/e296
  2. Ritchey AK, Pollock BH, Lauer SJ, Andejeski Y, Barredo J, Buchanan GR. Improved survival of children with isolated CNS relapse of acute lymphoblastic leukemia: a Pediatric Oncology Group study [published correction appears in J Clin Oncol. 2000;18:703]. J Clin Oncol. 1999;17 :3745 –3752[Abstract/Free Full Text]
  3. Barredo JC, Devidas M, Lauer SJ, et al. Isolated CNS relapse of acute lymphoblastic leukemia treated with intensive systemic chemotherapy and delayed CNS radiation: a Pediatric Oncology Group study. J Clin Oncol. 2006;24 :3142 –3149[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article
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