Leukemia

There are two major types of leukemias, acute and chronic. Acute leukemia may involve either lymphocytes (acute lymphoblastic leukemia or ALL) or myeloid cells (acute myelogenous leukemia or AML). There are many different types of ALL and AML depending on the particular cell that has become malignant. Chronic leukemia primarily affects the myeloid cells in the bone marrow (chronic myelogenous leukemia or CML) and is more commonly found in adults, although children and teenagers can also sometimes develop CML.

Treatments for leukemia

We use allogeneic bone marrow stem cell transplantation to treat a variety of childhood leukemias or cancers that involve the cells within the bone marrow (also referred to as hematopoietic cells). Allogeneic transplantation has an advantage over autologous transplantation as it provides a "graft versus leukemia effect": another person's healthy bone marrow kills residual leukemia cells and decreases the chance of relapse in the recipient. The disadvantage of allogeneic bone marrow stem cell transplantation is the risk of "graft versus host disease": another person's bone marrow attacks the recipient's body and causes a disease that affects skin, liver, gut and many other organs, requiring therapy with immunosuppressive drugs.

High risk leukemias in first remission

The UCSF Pediatric BMT Program provides transplant for "high risk leukemia patients" in first remission (such as acute myelogenous leukemia, Philadelphia chromosome positive acute lymphoblastic leukemia, and leukemia in infants) if a matched related donor is available.

Relapsed leukemias in children

Bone marrow stem cell transplantation is the treatment of choice for many children with acute leukemias whose leukemia has relapsed. The UCSF Pediatric BMT Program offers transplantation from related donors (such as brothers, sisters or occasionally parents), and matched unrelated donors, including umbilical cord blood. The transplant can be done for children with relapsed leukemia once the leukemia is put in remission (i.e., no leukemia is seen in the bone marrow) with chemotherapy. Protocols for children with relapsed leukemia use total body irradiation and chemotherapy for conditioning (treatment prior to transplant). Our program also offers research protocols that look into decreasing the recurrence rate of leukemia by using additional donor T cells after the transplant (donor lymphocyte infusions or DLI).

Chronic myelogenous leukemia

Children with chronic myelogenous leukemia who cannot be put into complete remission with drugs such as Gleevec, should undergo a transplant from a related or unrelated donor as early as possible in the course of the disease. Currently, we offer a research protocol that utilizes an optimal dose of a potent chemotherapy drug called busulfan along with fludarabine, a drug that effectively prevents rejection of the donor cells with minimal toxicity.