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Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission.
J Clin Oncol. 2004 Jul 15; 22(14):2816-25.JC

Abstract

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+Show Affiliations

Clinic for Bone Marrow Transplantation and Hematology/Oncology, Dr-Ottmar-Kohler-Strasse 2, 55743 Idar-Oberstein, Germany. mkiehl@bmt-center-io.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

15254049

Citation

Kiehl, Michael G., et al. "Outcome of Allogeneic Hematopoietic Stem-cell Transplantation in Adult Patients With Acute Lymphoblastic Leukemia: No Difference in Related Compared With Unrelated Transplant in First Complete Remission." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 22, no. 14, 2004, pp. 2816-25.
Kiehl MG, Kraut L, Schwerdtfeger R, et al. Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission. J Clin Oncol. 2004;22(14):2816-25.
Kiehl, M. G., Kraut, L., Schwerdtfeger, R., Hertenstein, B., Remberger, M., Kroeger, N., Stelljes, M., Bornhaeuser, M., Martin, H., Scheid, C., Ganser, A., Zander, A. R., Kienast, J., Ehninger, G., Hoelzer, D., Diehl, V., Fauser, A. A., & Ringden, O. (2004). Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 22(14), 2816-25.
Kiehl MG, et al. Outcome of Allogeneic Hematopoietic Stem-cell Transplantation in Adult Patients With Acute Lymphoblastic Leukemia: No Difference in Related Compared With Unrelated Transplant in First Complete Remission. J Clin Oncol. 2004 Jul 15;22(14):2816-25. PubMed PMID: 15254049.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission. AU - Kiehl,Michael G, AU - Kraut,Ludwig, AU - Schwerdtfeger,Rainer, AU - Hertenstein,Bernd, AU - Remberger,Mats, AU - Kroeger,Nicolaus, AU - Stelljes,Mathias, AU - Bornhaeuser,Martin, AU - Martin,Hans, AU - Scheid,Christoph, AU - Ganser,Arnold, AU - Zander,Axel R, AU - Kienast,Joachim, AU - Ehninger,Gerhard, AU - Hoelzer,Dieter, AU - Diehl,Volker, AU - Fauser,Axel A, AU - Ringden,Olle, PY - 2004/7/16/pubmed PY - 2004/9/4/medline PY - 2004/7/16/entrez SP - 2816 EP - 25 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 22 IS - 14 N2 - 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. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/15254049/Outcome_of_allogeneic_hematopoietic_stem_cell_transplantation_in_adult_patients_with_acute_lymphoblastic_leukemia:_no_difference_in_related_compared_with_unrelated_transplant_in_first_complete_remission_ L2 - https://ascopubs.org/doi/10.1200/JCO.2004.07.130?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -