BACKGROUND: Allogeneic hematopoietic cell transplantation is a potentially curative treatment for patients with acute lymphoblastic leukemia. However, the majority of older adults with acute lymphoblastic leukemia are not candidates for myeloablative conditioning regimens. A non-myeloablative preparative regimen is a reasonable treatment option for this group. We sought to determine the outcome of non-myeloablative conditioning and allogeneic transplantation in patients with high-risk acute lymphoblastic leukemia. DESIGN AND METHODS: Fifty-one patients (median age 56 years) underwent allogeneic hematopoietic cell transplantation from sibling or unrelated donors after fludarabine and 2 Gray total body irradiation. Twenty-five patients had Philadelphia chromosome-positive acute lymphoblastic leukemia. Eighteen of these patients received post-grafting imatinib. RESULTS: With a median follow-up of 43 months, the 3-year overall survival was 34%. The 3-year relapse/progression and non-relapse mortality rates were 40% and 28%, respectively. The cumulative incidences of grades II and III-IV acute graft-versus-host disease were 53% and 6%, respectively. The cumulative incidence of chronic graft-versus-host disease was 44%. Hematopoietic cell transplantation in first complete remission and post-grafting imatinib were associated with improved survival (P=0.005 and P=0.03, respectively). Three-year overall survival rates for patients with Philadelphia-negative acute lymphoblastic leukemia in first remission and beyond first remission were 52% and 8%, respectively. For patients with Philadelphia chromosome-positive acute lymphoblastic leukemia in first remission who received post-grafting imatinib, the 3-year overall survival rate was 62%; for the subgroup without evidence of minimal residual disease at transplantation, the overall survival was 73%. CONCLUSIONS: For patients with high-risk acute lymphoblastic leukemia in first complete remission, non-myeloablative conditioning and allogeneic hematopoietic cell transplantation, with post-grafting imatinib for Philadelphia chromosome-positive disease, can result in favorable long-term survival.
BACKGROUND: Allogeneic hematopoietic cell transplantation is a potentially curative treatment for patients with acute lymphoblastic leukemia. However, the majority of older adults with acute lymphoblastic leukemia are not candidates for myeloablative conditioning regimens. A non-myeloablative preparative regimen is a reasonable treatment option for this group. We sought to determine the outcome of non-myeloablative conditioning and allogeneic transplantation in patients with high-risk acute lymphoblastic leukemia. DESIGN AND METHODS: Fifty-one patients (median age 56 years) underwent allogeneic hematopoietic cell transplantation from sibling or unrelated donors after fludarabine and 2 Gray total body irradiation. Twenty-five patients had Philadelphia chromosome-positive acute lymphoblastic leukemia. Eighteen of these patients received post-grafting imatinib. RESULTS: With a median follow-up of 43 months, the 3-year overall survival was 34%. The 3-year relapse/progression and non-relapse mortality rates were 40% and 28%, respectively. The cumulative incidences of grades II and III-IV acute graft-versus-host disease were 53% and 6%, respectively. The cumulative incidence of chronic graft-versus-host disease was 44%. Hematopoietic cell transplantation in first complete remission and post-grafting imatinib were associated with improved survival (P=0.005 and P=0.03, respectively). Three-year overall survival rates for patients with Philadelphia-negative acute lymphoblastic leukemia in first remission and beyond first remission were 52% and 8%, respectively. For patients with Philadelphia chromosome-positive acute lymphoblastic leukemia in first remission who received post-grafting imatinib, the 3-year overall survival rate was 62%; for the subgroup without evidence of minimal residual disease at transplantation, the overall survival was 73%. CONCLUSIONS: For patients with high-risk acute lymphoblastic leukemia in first complete remission, non-myeloablative conditioning and allogeneic hematopoietic cell transplantation, with post-grafting imatinib for Philadelphia chromosome-positive disease, can result in favorable long-term survival.
Authors: Jan J Cornelissen; Bronno van der Holt; Gregor E G Verhoef; Mars B van't Veer; Marinus H J van Oers; Harry C Schouten; Gert Ossenkoppele; Pieter Sonneveld; Johan Maertens; Marinus van Marwijk Kooy; Martijn R Schaafsma; Pierre W Wijermans; Douwe H Biesma; Shulamit Wittebol; Paul J Voogt; Joke W Baars; Pierre Zachée; Leo F Verdonck; Bob Löwenberg; Adriaan W Dekker Journal: Blood Date: 2008-11-06 Impact factor: 22.113
Authors: Anthony S Stein; Joycelynne M Palmer; Margaret R O'Donnell; Neil M Kogut; Ricardo T Spielberger; Marilyn L Slovak; Ni-Chun Tsai; David Senitzer; David S Snyder; Sandra H Thomas; Stephen J Forman Journal: Biol Blood Marrow Transplant Date: 2009-11 Impact factor: 5.742
Authors: Mohamed Sorror; Barry Storer; Brenda M Sandmaier; David G Maloney; Thomas R Chauncey; Amelia Langston; Richard T Maziarz; Michael Pulsipher; Peter A McSweeney; Rainer Storb Journal: Cancer Date: 2008-05-01 Impact factor: 6.860
Authors: Anthony H Goldstone; Susan M Richards; Hillard M Lazarus; Martin S Tallman; Georgina Buck; Adele K Fielding; Alan K Burnett; Raj Chopra; Peter H Wiernik; Letizia Foroni; Elisabeth Paietta; Mark R Litzow; David I Marks; Jill Durrant; Andrew McMillan; Ian M Franklin; Selina Luger; Niculae Ciobanu; Jacob M Rowe Journal: Blood Date: 2007-11-29 Impact factor: 22.113
Authors: Adele K Fielding; Jacob M Rowe; Susan M Richards; Georgina Buck; Anthony V Moorman; I Jill Durrant; David I Marks; Andrew K McMillan; Mark R Litzow; Hillard M Lazarus; Letizia Foroni; Gordon Dewald; Ian M Franklin; Selina M Luger; Elisabeth Paietta; Peter H Wiernik; Martin S Tallman; Anthony H Goldstone Journal: Blood Date: 2009-02-24 Impact factor: 22.113
Authors: G Kunter; J B Perkins; J Pidala; T Nishihori; M A Kharfan-Dabaja; T Field; H Fernandez; L Perez; F Locke; E Ayala; M Tomblyn; J L Ochoa-Bayona; B Betts; M Nieder; C Anasetti Journal: Bone Marrow Transplant Date: 2013-09-02 Impact factor: 5.483
Authors: Rainer Storb; Boglarka Gyurkocza; Barry E Storer; Mohamed L Sorror; Karl Blume; Dietger Niederwieser; Thomas R Chauncey; Michael A Pulsipher; Finn B Petersen; Firoozeh Sahebi; Edward D Agura; Parameswaran Hari; Benedetto Bruno; Peter A McSweeney; Michael B Maris; Richard T Maziarz; Amelia A Langston; Wolfgang Bethge; Lars Vindeløv; Georg-Nikolaus Franke; Ginna G Laport; Andrew M Yeager; Kai Hübel; H Joachim Deeg; George E Georges; Mary E D Flowers; Paul J Martin; Marco Mielcarek; Ann E Woolfrey; David G Maloney; Brenda M Sandmaier Journal: J Clin Oncol Date: 2013-03-11 Impact factor: 44.544