Results:
Patients: Patient characteristics are summarised in Table 1. A
cohort of eight pediatric patients with primary refractory or
multiply-relapsed acute leukemia was analysed. The median age was 8,5
years (range 1 year – 18 years). Three patients had a primary
refractory leukemia, including two patients with an acute lymphoblastic
leukemia and one patient with an acute biphenotypic leukemia. Five
patients had a multiply-relapsed leukemia, including 2 patients with an
acute myeloid leukemia, two patients with an acute B-cell precursor
lymphoblastic leukemia and one patient with an acute T-lymphoblastic
lymphoma. 75 % of the patients had a high risk cytogenetic
constellation. All patients had received ≥ three regimens of
chemotherapy before the melphalan / cytarabine therapy and four patients
(50%) had received a prior allogeneic HSCT before the melphalan /
cytarabine therapy. All patients had documented BM - involvement prior
to the salvage therapy melphalan / cytarabine. Response was evaluated in
BM before and after melphalan and cytarabine. In three of the eight
cases (38%) only a remission in peripheral blood was documented between
the salvage therapy and the allogeneic HSCT and a bone marrow puncture
was performed after the HSCT. The aim of this practice was to minimize
the amount of invasive procedures in order to reduce the pain and
psychological stress in the children.