Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 1043 (doi:10.1542/10.1542/peds.2007-0656)

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LETTER TO THE EDITOR

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

Ammar Hayani, MD
Section of Pediatric Hematology/Oncology
Advocate Hope Children's Hospital
Oak Lawn, IL 60453

In general, central nervous system relapse is not a clear and absolute indication for hematopoietic stem cell transplantation in children with acute lymphoblastic leukemia. However, early central nervous system relapse is associated with poor outcome when treated with conventional chemotherapy and radiation therapy. Although there have not been any randomized studies to establish an advantage of stem cell transplantation, such transplantation seems to provide better survival rates compared with conventional therapy (77% vs 46%).^1,2 In our patient, the very early onset of relapse (only 10 months) and the fact that she relapsed while receiving a more intensive chemotherapy regimen for high-risk leukemia put her at a high risk for treatment failure if she had been treated with conventional therapy. These factors led us to favor hematopoietic stem cell transplantation over conventional chemotherapy and radiotherapy.

Given the fact that the patient was still relatively young at the time of transplant and the viability of cord blood was excellent, we felt that the risk of graft failure was small, and collection of backup stem cells was not necessary. Autologous stem cells would have also had the possibility of being contaminated with residual leukemia cells.

We played no role in the family's decision to collect and save our patient's cord blood, and our report does not advocate private cord blood collection. One case report does not establish the efficacy or safety of autologous cord blood transplantation. It would be considered inappropriate for anyone to use this report as an argument in favor of private cord blood collection. Our main objective in writing the report was to discuss feasibility, safety, and uncertainties of autologous cord blood transplantation. We do believe that for children with high-risk relapsed leukemia in whom cord blood has been collected, the option of autologous cord blood transplantation should be considered and its risks and benefits should be weighed against conventional therapy and allogeneic stem cell transplantation.

REFERENCES

1. Bordigoni P, Esperou H, Souillet G, et al. Total body irradiation-high-dose cytosine arabinoside and melphalan followed by allogeneic bone marrow transplantation from HLA-identical siblings in the treatment of children with acute lymphoblastic leukaemia after relapse while receiving chemotherapy: a Societe Francaise de Greffe de Moelle study. Br J Haematol. 1998;102 :656 –665[CrossRef][Web of Science][Medline]
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]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hayani, A. Search for Related Content PubMed Articles by Hayani, A. Related Collections Blood Social Bookmarking                         What's this?