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To examine relapse, survival and transplant-related complications in relationship to disease- and pre-treatment-related characteristics, we evaluated 132 children, who consecutively received an allogeneic HLA-identical SCT for acute leukaemia in our centre: ALL in first remission (n=24), ALL in second remission (n=53) and AML in first remission (n=55). The source of the stem cells was bone marrow in all but three cases. Most patients (89%) were pre-treated with cyclophosphamide and an age-related dose of TBI. Initially, GVHD prophylaxis consisted of long-course MTX only (n=24), later short-course MTX and CsA (n=102) was given. All patients were nursed in strictly protective isolation and received total gut decontamination to suppress their potentially pathogenic enteric microflora. The 5-year probability of overall survival was 63, 53 and 74% for ALL1, ALL2 and AML1, respectively (median follow-up: 10.6 years). The overall transplant-related mortality was 6%. The incidence of acute GVHD was 17%; 6% was grades II-IV. A higher total biologically effective TBI dose (BED) resulted in a decreased relapse frequency (P=0.034) and increased overall survival. AML patients with acute GVHD got no relapse (P=0.02); this was not the case in ALL patients. Fractionated TBI regimens with higher BED should be evaluated in prospective studies.

Original publication




Journal article


Bone Marrow Transplant

Publication Date





319 - 327


Adolescent, Child, Child, Preschool, Dose-Response Relationship, Radiation, Female, Graft Survival, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Histocompatibility Testing, Humans, Infant, Kaplan-Meier Estimate, Leukemia, Myeloid, Acute, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Recurrence, Retrospective Studies, Transplantation Conditioning, Transplantation, Homologous, Whole-Body Irradiation