Treatment of Acute Lymphoblastic Leukemia in a Second Remission

To the Editor: Barrett et al. (Nov. 10 issue) 1 conclude that for children with acute lymphoblastic leukemia (ALL) in a second remission, bone marrow transplants from HLA-identical siblings result in fewer relapses and longer leukemia-free survival than does chemotherapy. This conclusion was based on a comparison of children whose cases were reported to the International Bone Marrow Transplant Registry and children treated with chemotherapy by the Pediatric Oncology Group. Their report arouses some concern. The comparison does not take into account possible differences between the two groups with respect to race or ethnic background, financial and nutritional status, and type . . .