PURPOSE: The role of unrelated allogeneic stem-cell transplantation in acute lymphoblastic leukemia (ALL) patients is still not clear, and only limited data are available from the literature. We analyzed factors affecting clinical outcome of ALL patients receiving a related or unrelated stem-cell graft from matched donors. PATIENTS AND METHODS: The total study population was 264 adult patients receiving a myeloablative allogeneic stem-cell transplant for ALL at nine bone marrow transplantation centers between 1990 and 2002. Of these, 221 patients receiving a matched related or unrelated graft were analyzed. One hundred forty-eight patients received transplantation in complete remission; 62 patients were in relapse; and 11 patients were refractory to chemotherapy before transplant. Fifty percent of patients received bone marrow, and 50% received peripheral blood stem cell from a human leukocyte antigen-identical related (n = 103), or matched unrelated (n = 118) donor. RESULTS: Disease-free survival (DFS) at 5 years was 28%, with 76 patients (34%) still alive (2.2 to 103 months post-transplantation), and 145 deceased (65 relapses, transplant-related mortality, 45%). We observed an advantage regarding DFS in favor of patients receiving transplantation during their first complete remission (CR) in comparison with patients receiving transplantation in or after second CR (P =.014) or who relapsed (P <.001). We observed a clear trend toward improved survival in favor of B-lineage ALL patients compared with T-lineage ALL patients (P =.052), and Philadelphia chromosome-positive patients had no poorer outcome than Philadelphia chromosome-negative patients. Total-body irradiation-based conditioning improved DFS in comparison with busulfan (P =.041). CONCLUSION: Myeloablative matched related or matched unrelated allogeneic hematopoietic stem-cell transplantation in ALL patients should be performed in first CR.
PURPOSE: The role of unrelated allogeneic stem-cell transplantation in acute lymphoblastic leukemia (ALL) patients is still not clear, and only limited data are available from the literature. We analyzed factors affecting clinical outcome of ALL patients receiving a related or unrelated stem-cell graft from matched donors. PATIENTS AND METHODS: The total study population was 264 adult patients receiving a myeloablative allogeneic stem-cell transplant for ALL at nine bone marrow transplantation centers between 1990 and 2002. Of these, 221 patients receiving a matched related or unrelated graft were analyzed. One hundred forty-eight patients received transplantation in complete remission; 62 patients were in relapse; and 11 patients were refractory to chemotherapy before transplant. Fifty percent of patients received bone marrow, and 50% received peripheral blood stem cell from a human leukocyte antigen-identical related (n = 103), or matched unrelated (n = 118) donor. RESULTS: Disease-free survival (DFS) at 5 years was 28%, with 76 patients (34%) still alive (2.2 to 103 months post-transplantation), and 145 deceased (65 relapses, transplant-related mortality, 45%). We observed an advantage regarding DFS in favor of patients receiving transplantation during their first complete remission (CR) in comparison with patients receiving transplantation in or after second CR (P =.014) or who relapsed (P <.001). We observed a clear trend toward improved survival in favor of B-lineage ALL patients compared with T-lineage ALL patients (P =.052), and Philadelphia chromosome-positive patients had no poorer outcome than Philadelphia chromosome-negative patients. Total-body irradiation-based conditioning improved DFS in comparison with busulfan (P =.041). CONCLUSION: Myeloablative matched related or matched unrelated allogeneic hematopoietic stem-cell transplantation in ALL patients should be performed in first CR.
Authors: Kristine Doney; Ted A Gooley; H Joachim Deeg; Mary E D Flowers; Rainer Storb; Frederick R Appelbaum Journal: Biol Blood Marrow Transplant Date: 2010-12-21 Impact factor: 5.742
Authors: David Valcárcel; Jorge Sierra; Tao Wang; Fangyu Kan; Vikas Gupta; Gregory A Hale; David I Marks; Philip L McCarthy; Machteld Oudshoorn; Effie W Petersdorf; Olle Ringdén; Michelle Setterholm; Stephen R Spellman; Edmund K Waller; James L Gajewski; Susana R Marino; David Senitzer; Stephanie J Lee Journal: Biol Blood Marrow Transplant Date: 2010-07-30 Impact factor: 5.742
Authors: Olle Ringdén; Steven Z Pavletic; Claudio Anasetti; A John Barrett; Tao Wang; Dan Wang; Joseph H Antin; Paolo Di Bartolomeo; Brian J Bolwell; Christopher Bredeson; Mitchell S Cairo; Robert P Gale; Vikas Gupta; Theresa Hahn; Gregory A Hale; Jorg Halter; Madan Jagasia; Mark R Litzow; Franco Locatelli; David I Marks; Philip L McCarthy; Morton J Cowan; Effie W Petersdorf; James A Russell; Gary J Schiller; Harry Schouten; Stephen Spellman; Leo F Verdonck; John R Wingard; Mary M Horowitz; Mukta Arora Journal: Blood Date: 2008-12-04 Impact factor: 22.113
Authors: Priya Kumar; Todd E Defor; Claudio Brunstein; Juliet N Barker; John E Wagner; Daniel J Weisdorf; Linda J Burns Journal: Biol Blood Marrow Transplant Date: 2008-12 Impact factor: 5.742