Abstract
Double stem cell autografts (DSCA) utilizing two different types of cytoreduction regimens with a 1-2 month interval were applied to the treatment of childhood acute lymphoblastic leukemia (ALL) with very high-risk features. Four patients, from whom sufficient progenitors were collected from the peripheral blood, were planned to receive one-third of the collected cells at the first transplant, and the remaining two-thirds at the second transplant. For two other patients, autologous bone marrow transplantation (ABMT) was planned at the first transplant and PBSCT at the second one. A combination of high-dose melphalan (L-PAM; 120-180 mg/m2) and etopside (200 mg/m2×8) was the cytoreductive regimen for the first transplant and the MCVAC regimen was used for the second transplant. Six patients were scheduled to undergo DSCA, but one patients subsequently was excluded due to early relapse and an other died from veno-occulusive disease after the first transplant, leaving us four patients for DSCA, However, all patients developed relapse 2-12 months after the 2nd PBSCT. DSCA could be performed safely in children with very high-risk ALL, but its efficacy to induce a long-term remission was questioned. A further trial will be required to address this.
