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Myeloablative hematopoietic cell transplantation for acute lymphoblastic leukemia: analysis of graft sources and long-term outcome.
J Clin Oncol. 2009 Aug 01; 27(22):3634-41.JC

Abstract

PURPOSE

Analysis of hematopoietic cell transplantation (HCT) for high-risk or recurrent acute lymphoblastic leukemia (ALL) using different donor sources is confounded by variable conditioning and supportive care.

PATIENTS AND METHODS

We studied 623 consecutive ALL myeloablative HCT (1980 to 2005). Donors were autologous (n = 209), related (RD; n = 245), unrelated (URD; n = 100), and umbilical cord blood (UCB; n = 69).

RESULTS

After median of 8.3 years of follow-up, 5-year overall survival (OS), leukemia-free survival (LFS), and relapse were 29% (95% CI, 26% to 32%), 26% (95% CI, 23% to 29%), and 43% (95% CI, 39% to 47%), respectively. Treatment-related mortality (TRM) at 2 years was 28% (95% CI, 25% to 31%). Mismatched URD sources yielded higher TRM (relative risk [RR], 2.2; P < .01) and lower OS (RR, 1.5; P = .05) than RD or UCB HCT. Autografting yielded significantly more relapse (68%; 95% CI, 59% to 77%; P < .01) and poorer LFS (14%; 95% CI, 10% to 18%; P = .01). HCT in first complete remission (CR1) yielded significantly better outcomes than later HCT. In a 1990 to 2005 allogeneic CR1/second complete response cohort, 5-year OS, LFS, and relapse rates were 41% (95% CI, 35% to 47%), 38% (95% CI, 32% to 44%), and 25% (95% CI, 19% to 31%), respectively; 2-year TRM was 34% (95% CI, 28% to 40%). With RD, well-matched URD and UCB sources, 5-year LFS was 40% (95% CI, 31% to 49%), 42% (95% CI, 14% to 70%), and 49% (95% CI, 34% to 64%), respectively, while relapse was 31% (95% CI, 22% to 40%), 17% (95% CI, 0% to 37%), and 27% (95% CI, 13% to 41%). Acute graft-versus-host disease was associated with fewer relapses. Since 1995, we noted progressive improvements in OS, LFS, and TRM.

CONCLUSION

Allogeneic, but not autologous, HCT for ALL results in durable LFS. Importantly, HCT using UCB led to similar outcomes as either RD or well-matched URD. HCT in early remission can best exploit the potent antileukemic efficacy of allografting from UCB, RD, or URD sources.

Authors+Show Affiliations

Department of Therapeutic Radiology and Radiation Oncology, University of Minnesota, Minneapolis, MN 55455, USA.No 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19581540

Citation

Tomblyn, Michael B., et al. "Myeloablative Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia: Analysis of Graft Sources and Long-term Outcome." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 27, no. 22, 2009, pp. 3634-41.
Tomblyn MB, Arora M, Baker KS, et al. Myeloablative hematopoietic cell transplantation for acute lymphoblastic leukemia: analysis of graft sources and long-term outcome. J Clin Oncol. 2009;27(22):3634-41.
Tomblyn, M. B., Arora, M., Baker, K. S., Blazar, B. R., Brunstein, C. G., Burns, L. J., DeFor, T. E., Dusenbery, K. E., Kaufman, D. S., Kersey, J. H., MacMillan, M. L., McGlave, P. B., Miller, J. S., Orchard, P. J., Slungaard, A., Tomblyn, M. R., Vercellotti, G. M., Verneris, M. R., Wagner, J. E., & Weisdorf, D. J. (2009). Myeloablative hematopoietic cell transplantation for acute lymphoblastic leukemia: analysis of graft sources and long-term outcome. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 27(22), 3634-41. https://doi.org/10.1200/JCO.2008.20.2960
Tomblyn MB, et al. Myeloablative Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia: Analysis of Graft Sources and Long-term Outcome. J Clin Oncol. 2009 Aug 1;27(22):3634-41. PubMed PMID: 19581540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myeloablative hematopoietic cell transplantation for acute lymphoblastic leukemia: analysis of graft sources and long-term outcome. AU - Tomblyn,Michael B, AU - Arora,Mukta, AU - Baker,K Scott, AU - Blazar,Bruce R, AU - Brunstein,Claudio G, AU - Burns,Linda J, AU - DeFor,Todd E, AU - Dusenbery,Kathryn E, AU - Kaufman,Dan S, AU - Kersey,John H, AU - MacMillan,Margaret L, AU - McGlave,Philip B, AU - Miller,Jeffrey S, AU - Orchard,Paul J, AU - Slungaard,Arne, AU - Tomblyn,Marcie R, AU - Vercellotti,Gregory M, AU - Verneris,Michael R, AU - Wagner,John E, AU - Weisdorf,Daniel J, Y1 - 2009/07/06/ PY - 2009/7/8/entrez PY - 2009/7/8/pubmed PY - 2009/8/21/medline SP - 3634 EP - 41 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 27 IS - 22 N2 - PURPOSE: Analysis of hematopoietic cell transplantation (HCT) for high-risk or recurrent acute lymphoblastic leukemia (ALL) using different donor sources is confounded by variable conditioning and supportive care. PATIENTS AND METHODS: We studied 623 consecutive ALL myeloablative HCT (1980 to 2005). Donors were autologous (n = 209), related (RD; n = 245), unrelated (URD; n = 100), and umbilical cord blood (UCB; n = 69). RESULTS: After median of 8.3 years of follow-up, 5-year overall survival (OS), leukemia-free survival (LFS), and relapse were 29% (95% CI, 26% to 32%), 26% (95% CI, 23% to 29%), and 43% (95% CI, 39% to 47%), respectively. Treatment-related mortality (TRM) at 2 years was 28% (95% CI, 25% to 31%). Mismatched URD sources yielded higher TRM (relative risk [RR], 2.2; P < .01) and lower OS (RR, 1.5; P = .05) than RD or UCB HCT. Autografting yielded significantly more relapse (68%; 95% CI, 59% to 77%; P < .01) and poorer LFS (14%; 95% CI, 10% to 18%; P = .01). HCT in first complete remission (CR1) yielded significantly better outcomes than later HCT. In a 1990 to 2005 allogeneic CR1/second complete response cohort, 5-year OS, LFS, and relapse rates were 41% (95% CI, 35% to 47%), 38% (95% CI, 32% to 44%), and 25% (95% CI, 19% to 31%), respectively; 2-year TRM was 34% (95% CI, 28% to 40%). With RD, well-matched URD and UCB sources, 5-year LFS was 40% (95% CI, 31% to 49%), 42% (95% CI, 14% to 70%), and 49% (95% CI, 34% to 64%), respectively, while relapse was 31% (95% CI, 22% to 40%), 17% (95% CI, 0% to 37%), and 27% (95% CI, 13% to 41%). Acute graft-versus-host disease was associated with fewer relapses. Since 1995, we noted progressive improvements in OS, LFS, and TRM. CONCLUSION: Allogeneic, but not autologous, HCT for ALL results in durable LFS. Importantly, HCT using UCB led to similar outcomes as either RD or well-matched URD. HCT in early remission can best exploit the potent antileukemic efficacy of allografting from UCB, RD, or URD sources. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/19581540/Myeloablative_hematopoietic_cell_transplantation_for_acute_lymphoblastic_leukemia:_analysis_of_graft_sources_and_long_term_outcome_ L2 - https://ascopubs.org/doi/10.1200/JCO.2008.20.2960?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -