Allogeneic bone marrow transplantation for patients with high-risk acute lymphoblastic leukemia

J. R. Wingard, S. Piantadosi, G. W. Santos, R. Saral, H. M. Vriesendorp, A. M. Yeager, W. H. Burns, R. F. Ambinder, H. G. Braine, G. Elfenbein, R. J. Jones, H. Kaizer, W. Stratford May, S. D. Rowley, L. L. Sensenbrenner, R. K. Stuart, P. J. Tutschka, G. B. Vogelsang, J. E. Wanger

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75 Scopus citations

Abstract

Seventy-four consecutive patients with high-risk acute lymphoblastic leukemia (ALL) were given cyclophosphamide (CY; 50 mg/kg on each of 4 days) plus total body irradiation (TBI; 300 rad on each of 4 days) followed by a human leukocyte antigen (HLA)-identical allogeneic bone marrow transplant (BMT). Eighteen patients in first complete remision (CR1), 36 in CR2, 16 in CR3, and four in CR4 were transplanted. Patients in CR1 were transplanted 1 to 8 months (median, 3 months) after attaining CR. All 18 patients in CR1 had one or more poor risk factors: age more than 18 (N = 17), initial leukocyte count ≥ 20,000 (N = 11), Ph1 chromosome (N = 2), delay in attaining CR more than 6 weeks (N = 8), or extramedullary disease (N = 1). Of those transplanted in CR2, 72% had relapsed on therapy. The 5-year event-free survival (EFS) rates for patients transplanted in CR1, CR2, and CR3 are 42%, 43%, and 25%, respectively, at median follow-up times of 57, 54, and 72 months, respectively. Children aged less than 18 years transplanted in CR2 have a 5-year EFS rate of 54%. All CR4 patients died early after transplant. The actuarial probability of relapse is 20%, 26%, and 48% for those transplanted in CR1, CR2, and CR3, respectively. Although there was substantial transplant-associated mortality, it decreased over the decade of the study (P = .01). This study indicates that BMT offers an attractive alternative to postremission chemotherapy in patients in CR1 with poor prognostic factors and in patients in second remission.

Original languageEnglish (US)
Pages (from-to)820-830
Number of pages11
JournalJournal of Clinical Oncology
Volume8
Issue number5
DOIs
StatePublished - 1990

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