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Unrelated transplantation for poor-prognosis adult acute lymphoblastic leukemia: long-term outcome analysis and study of the impact of hematopoietic graft source.
Biol Blood Marrow Transplant. 2010 Jul; 16(7):957-66.BB

Abstract

Adults with high-risk acute lymphoblastic leukemia (HR-ALL) have a poor outcome with standard chemotherapy and usually undergo unrelated stem cell transplantation (SCT) if a matched sibling donor is not available. We analyzed the outcome of adult patients with unrelated SCT for HR-ALL and studied the possible effect of the hematopoietic stem cell source of the transplant. A total of 149 adult patients (median age, 29 years, range, 15-59 years) with HR-ALL underwent unrelated SCT in 13 Spanish institutions between 2000 and 2007. Patients in first complete remission (CR1) at transplantation had at least one adverse prognostic factor (advanced age, adverse cytogenetics, hyperleukocytosis, or slow response to induction therapy). ALL was in CR1 in 81 patients (54%), in second CR (CR2) in 37 patients (25%), in third CR (CR3) in 11 patients (7%), and with overt disease in 20 patients (13%). The hematopoietic source was unrelated cord blood (UCB) in 62 patients and an unrelated donor (UD) in 87 patients. The patients undergoing UCB-SCT and UD-SCT were comparable in terms of the main clinical and biological features of ALL, except for a higher frequency of patients with more overt disease in the UCB-SCT group. There was no statistically significant difference in overall survival (OS) or disease-free survival (DFS) at 5 years between the 2 groups. Treatment-related mortality (TRM) was significantly lower in the UCB-SCT group (P = .021). The probability of relapse at 1 year was 17% (95% confidence interval [CI], 7%-27%) for the UD-SCT group and 27% (95% CI, 14%-40%) for the UCB-SCT group (P = .088), respectively. Only disease status at transplantation (CR1, 41% [95% CI, 18%-64%] vs CR2, 51% [95% CI, 17%-85%] vs advanced disease, 66% [95% CI, 46%-86%]; P = .001) and the absence of chronic graft-versus-host disease (74% [95% CI, 46%-100%] vs 33% [95% CI, 17%-49%]; P = .034) were significant factors for relapse. All unrelated transplantation modalities were associated with high treatment-related mortality for adult HR-ALL patients without a sibling donor. UCB-SCT and UD-SCT were found to be equivalent options. Disease status at transplantation and chronic GVHD were the main factors influencing relapse in both transplantation modalities.

Authors+Show Affiliations

Hospital Universitari Germans Trias i Pujol, Badalona, Spain.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 availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20144909

Citation

Ferrá, Christelle, et al. "Unrelated Transplantation for Poor-prognosis Adult Acute Lymphoblastic Leukemia: Long-term Outcome Analysis and Study of the Impact of Hematopoietic Graft Source." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 16, no. 7, 2010, pp. 957-66.
Ferrá C, Sanz J, de la Cámara R, et al. Unrelated transplantation for poor-prognosis adult acute lymphoblastic leukemia: long-term outcome analysis and study of the impact of hematopoietic graft source. Biol Blood Marrow Transplant. 2010;16(7):957-66.
Ferrá, C., Sanz, J., de la Cámara, R., Sanz, G., Bermúdez, A., Valcárcel, D., Rovira, M., Serrano, D., Caballero, D., Espigado, I., Morgades, M., Heras, I., Solano, C., Duarte, R., Barrenetxea, C., García-Noblejas, A., Díez-Martin, J. L., Iriondo, A., Carreras, E., ... Ribera, J. M. (2010). Unrelated transplantation for poor-prognosis adult acute lymphoblastic leukemia: long-term outcome analysis and study of the impact of hematopoietic graft source. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 16(7), 957-66. https://doi.org/10.1016/j.bbmt.2010.02.003
Ferrá C, et al. Unrelated Transplantation for Poor-prognosis Adult Acute Lymphoblastic Leukemia: Long-term Outcome Analysis and Study of the Impact of Hematopoietic Graft Source. Biol Blood Marrow Transplant. 2010;16(7):957-66. PubMed PMID: 20144909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unrelated transplantation for poor-prognosis adult acute lymphoblastic leukemia: long-term outcome analysis and study of the impact of hematopoietic graft source. AU - Ferrá,Christelle, AU - Sanz,Jaime, AU - de la Cámara,Rafael, AU - Sanz,Guillermo, AU - Bermúdez,Arancha, AU - Valcárcel,David, AU - Rovira,Montserrat, AU - Serrano,David, AU - Caballero,Dolores, AU - Espigado,Ildefonso, AU - Morgades,Mireia, AU - Heras,Inmaculada, AU - Solano,Carlos, AU - Duarte,Rafael, AU - Barrenetxea,Cristina, AU - García-Noblejas,Ana, AU - Díez-Martin,José L, AU - Iriondo,Arturo, AU - Carreras,Enric, AU - Sierra,Jordi, AU - Sanz,Miguel-Angel, AU - Ribera,Josep-Maria, AU - ,, Y1 - 2010/02/07/ PY - 2009/12/23/received PY - 2010/02/01/accepted PY - 2010/2/11/entrez PY - 2010/2/11/pubmed PY - 2011/1/5/medline SP - 957 EP - 66 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 16 IS - 7 N2 - Adults with high-risk acute lymphoblastic leukemia (HR-ALL) have a poor outcome with standard chemotherapy and usually undergo unrelated stem cell transplantation (SCT) if a matched sibling donor is not available. We analyzed the outcome of adult patients with unrelated SCT for HR-ALL and studied the possible effect of the hematopoietic stem cell source of the transplant. A total of 149 adult patients (median age, 29 years, range, 15-59 years) with HR-ALL underwent unrelated SCT in 13 Spanish institutions between 2000 and 2007. Patients in first complete remission (CR1) at transplantation had at least one adverse prognostic factor (advanced age, adverse cytogenetics, hyperleukocytosis, or slow response to induction therapy). ALL was in CR1 in 81 patients (54%), in second CR (CR2) in 37 patients (25%), in third CR (CR3) in 11 patients (7%), and with overt disease in 20 patients (13%). The hematopoietic source was unrelated cord blood (UCB) in 62 patients and an unrelated donor (UD) in 87 patients. The patients undergoing UCB-SCT and UD-SCT were comparable in terms of the main clinical and biological features of ALL, except for a higher frequency of patients with more overt disease in the UCB-SCT group. There was no statistically significant difference in overall survival (OS) or disease-free survival (DFS) at 5 years between the 2 groups. Treatment-related mortality (TRM) was significantly lower in the UCB-SCT group (P = .021). The probability of relapse at 1 year was 17% (95% confidence interval [CI], 7%-27%) for the UD-SCT group and 27% (95% CI, 14%-40%) for the UCB-SCT group (P = .088), respectively. Only disease status at transplantation (CR1, 41% [95% CI, 18%-64%] vs CR2, 51% [95% CI, 17%-85%] vs advanced disease, 66% [95% CI, 46%-86%]; P = .001) and the absence of chronic graft-versus-host disease (74% [95% CI, 46%-100%] vs 33% [95% CI, 17%-49%]; P = .034) were significant factors for relapse. All unrelated transplantation modalities were associated with high treatment-related mortality for adult HR-ALL patients without a sibling donor. UCB-SCT and UD-SCT were found to be equivalent options. Disease status at transplantation and chronic GVHD were the main factors influencing relapse in both transplantation modalities. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/20144909/Unrelated_transplantation_for_poor_prognosis_adult_acute_lymphoblastic_leukemia:_long_term_outcome_analysis_and_study_of_the_impact_of_hematopoietic_graft_source_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(10)00058-3 DB - PRIME DP - Unbound Medicine ER -