Comparison of Autologous and Allogeneic Bone Marrow Transplantation for Treatment of High-Risk Refractory Acute Lymphoblastic Leukemia

John H. Kersey, Daniel Weisdorf, Mark E. Nesbit, Tucker W. Lebien, William G. Woods, Philip B. McGlave, Tae Kim, Daniel A. Vallera, Anne I. Goldman, Bruce Bostrom, David Hurd, Norma K.c. Ramsay

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Abstract

Chemoradiotherapy and transplantation of bone marrow from matched sibling donors have been useful for the treatment of acute lymphoblastic leukemia in patients with a poor prognosis but are not available to some two thirds of patients who do not have a matched allogeneic donor. We undertook this study to compare autologous and allogeneic marrow transplantation in the treatment of such cases. We treated 91 patients with high-dose chemoradiotherapy and followed them for 1.4 to 5 years. Forty-six patients with an HLA-matched donor received allogeneic marrow, and 45 patients without a matched donor received their own marrow taken during remission and purged of leukemic cells with use of monoclonal antibodies. Bone marrow engraftment occurred earlier in patients who received autologous marrow. Recipients of autologous marrow had shorter hospital courses, with significantly fewer peritransplantation deaths than recipients of allogeneic marrow. Post-transplantation relapse of leukemia was the most frequent cause of treatment failure; relapses occurred in an estimated 37 percent of patients with allogeneic grafts in whom graft-versus-host disease developed, 75 percent of patients with allogeneic grafts in whom graft-versus-host disease did not develop, and 79 percent of patients who received autologous grafts. The interval before relapse was significantly shorter in the autologous-marrow group than in the allogeneic-marrow group. Recipients of autologous and allogeneic marrow whose first pretransplantation remissions were short (less than 18 months) had eventual outcomes similar to those whose first remissions were longer than 18 months. Patients with a first remission lasting less than 18 months had an outcome better than that expected with chemotherapy alone. The fractions of “cured” patients were estimated to be 20 percent in the autologous-marrow group and 27 percent in the allogeneic-marrow group — not a significant difference, but because of the limited statistical power of the study, the question of long-term disease-free survival must still be considered open. (N Engl J Med 1987; 317:461–7.), RECENT advances in understanding the biology and therapy of acute lymphoblastic leukemia have had a considerable effect on survival in this heterogeneous group of diseases; long-term disease-free survival rates of 50 to 75 percent are now observed in patients who receive chemotherapy.1 2 3 4 5 Although certain patients at the time of diagnosis and most patients in whom primary chemotherapy fails have a very poor prognosis with conventional therapy,6,7 some patients who have a first remission lasting more than 18 months will have a prolonged second remission with chemotherapy alone.8,9 Chemoradiotherapy followed by bone marrow transplantation from matched sibling donors has been used…

Original languageEnglish (US)
Pages (from-to)461-467
Number of pages7
JournalNew England Journal of Medicine
Volume317
Issue number8
DOIs
StatePublished - Aug 20 1987

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