Allogeneic bone marrow transplantation for acute lymphoblastic leukemia in remission: prolonged survival associated with acute graft-verus-host disease

D. J. Weisdorf, M. E. Nesbit, N. K.C. Ramsay, W. G. Woods, A. I. Goldman, T. H. Kim, D. D. Hurd, P. B. McGlave, J. H. Kersey

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Abstract

Forty remission patients with high-risk acute lymphoblastic leukemia (ALL) underwent matched allogeneic bone marrow transplantation (BMT) following preparation with cyclophosphamide and fractionated total body irradation (TBI). As of March 1987, the median follow-up is more than 3 1/2 years. Thirteen patient are alive (11 relapse free) between 2 and 4 1/2 years post-BMT. Neither age, sex, remission number, prior extramedullary leukemia, nor WBC at diagnosis of ALL was statistically significant as a predictor of relapse-free survival. The development of acute graft-versus-host disease (GVHD) in 17 patients was found, with time-dependent Cox regression analysis, to be associated with a significant reduction in post-BMT relapse risk (P=.04) and improved disease-free survival (P=.11). A prospective, randomized trial of maintenance chemotherapy with oral methotrexate and mercaptopurine did not demonstrate improvement in relapse risk or survival for those assigned maintenance chemotherapy (P=.7). These results suggest that allogeneic BMT can result in extended relapse-free survival for some patients with high-risk ALL. More effective preparative chemoradiotherapy and exploitation of the apparent graft-v-leukemia effect may be useful in future trials.

Original languageEnglish (US)
Pages (from-to)1348-1355
Number of pages8
JournalJournal of Clinical Oncology
Volume5
Issue number9
DOIs
StatePublished - 1987

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