Summary:In 1989 we carried out a trial comparing allogeneic BMT to chemotherapy (CT) in 76 children with relapsed acute lymphoblastic leukaemia (ALL). Ten years on we have clinically revised outcome to firmly establish the role of each treatment, to analyse the importance of length of first remission and to provide long-term actuarial results for disease-free survival (DFS) and relapse rate in each group. For 21 patients within the transplantation group, probability of DFS and relapse are 42.8 ± 10.8% and 40.2 ± 11.7% (s.e.), respectively. In the chemotherapy group, probability of DFS is 10.0 ± 4.74% (P = 0.001) and probability of relapse 87.5 ± 5.2% (P = 0.0004). These results strongly reflect those at initial analysis, confirming a key role of BMT in the management of ALL in second remission. Moreover, on univariate analysis only two factors influenced DFS: treatment group and length of first complete remission (less or more than 30 months from first CR). Thus, it seems clear that the best therapeutic option in early relapse is BMT, whereas DFS in late relapse is at the limit of significance (P = 0.07), with a higher relapse rate in the CT group. Although encouraging results using intensified rotational combination chemotherapy have been published, prospective randomised studies are needed to assess with certainty the best therapeutic option in these patients. Keywords: BMT vs chemotherapy; childhood ALL; second CR; revisited In 1989, we concluded that allogeneic bone marrow transplantation (BMT) is the best alternative therapy for children with ALL who have relapsed in their marrow. 1 In that report, we prospectively studied 76 such patients, 21 of whom had a genotypically identical HLA donor and underwent allogeneic BMT. The remaining 55 patients who lacked a suitable donor, received conventional chemotherapy (CT). Probability of survival was significantly higher in the BMT group (47.1 ± 11.7% vs 9.2 ± 5.6%, P Ͻ 0.025). Probability of remaining in complete remission in the BMT group was 58.5% vs 10.9% in the chemotherapy group (P Ͻ 0.005).At the time of publication of those findings and as a consequence of the discouraging results initially obtained by some groups with BMT for ALL patients in second CR, 2,3 many controversies arose, such as whether or not these children should undergo allogeneic BMT. [4][5][6][7] In the last 10 years, despite the lack of well-designed randomised studies with large numbers of patients, all results seem to confirm that high-dose chemotherapy and bone marrow transplantation from an histocompatible donor afford a greater chance of leukaemia-free survival than does conventional chemotherapy. However, it has been recently pointed out 8 that indications for BMT in ALL are not fully established, because of publications involving small numbers of patients, difficulties over selection bias since most patients lack a suitable sibling donor, and importantly, that a very long follow-up is needed to assess results of a second course of chemotherapy.On the other hand, it has been stated th...

The systems OrbiSac and TACSI can be used to produce buffy-coat-derived PCs whose cell content, platelet function and metabolism are similar during standard storage. However, the preparation with the OrbiSac system induces a transient increase in platelet activation and release of proinflammatory substances.

Double haemoglobin measurement with HemoCue [fingerstick and venous blood if required] is feasible and allows a significant recovery of blood donations.