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The superiority of allogeneic hematopoietic stem cell transplantation from unrelated donor over chemotherapy for adult patients with high-risk acute lymphoblastic leukemia in first remission.
Int J Hematol. 2013 Nov; 98(5):569-77.IJ

Abstract

For adult patients with acute lymphoblastic leukemia (ALL), allogeneic hematopoietic stem cell transplantation(allo-HSCT) from HLA-matched related donors(MSD) is recommended for standard and high-risk patients. The role of unrelated donor transplantation (URD) in first remission has not been fully determined. We sought to compare directly the outcome of URD allo-HSCT and chemotherapy in patients with high-risk ALL. In this single center retrospective analysis, we included 74 consecutive adult patients with high-risk ALL in first complete remission(CR) and without a sibling donor, in which 32 patients received URD allo-HSCT in CR1 with busulfan-cyclophosphamide preparation regimen and in vivo T-cell depletion with anti-T-lymphoglobulin (ATG). The remaining 42 patients received chemotherapy consolidation and maintenance only in first remission. With median follow-up of 18 months, in the URD allo-HSCT group, the relapse rate(RR) was 30.6 ± 11.4 % which was significantly lower than that of the chemotherapy group (80.5 ± 10.1 %,p < 0.001), while non-relapse mortality (NRM) was higher(16.4 ± 6.7 % vs. 0, p = 0.028). Overall, 3-year leukemia free survival (LFS) was superior in the URD allo-HSCT group compared to chemotherapy group (57.8 ± 10.6 vs.19.5 ± 10.5 %, p = 0.002), as was 3-year overall survival(OS, 63.5 ± 13.3 vs. 31.6 ± 10.6 %, p = 0.016). URDHSCT was the only factor associated with improved OS, LFS and reduced RR in multivariate analysis. Based on our data, URD allo-HSCT significantly reduced the relapse in high-risk ALL and the benefit translated into improvement in both LFS and OS. Prospective studies based on availability of HLA-matched URD are warranted to evaluate the precise role of URD transplantation in adult ALL.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

24078372

Citation

Wang, Ling, et al. "The Superiority of Allogeneic Hematopoietic Stem Cell Transplantation From Unrelated Donor Over Chemotherapy for Adult Patients With High-risk Acute Lymphoblastic Leukemia in First Remission." International Journal of Hematology, vol. 98, no. 5, 2013, pp. 569-77.
Wang L, Wang Y, Tang W, et al. The superiority of allogeneic hematopoietic stem cell transplantation from unrelated donor over chemotherapy for adult patients with high-risk acute lymphoblastic leukemia in first remission. Int J Hematol. 2013;98(5):569-77.
Wang, L., Wang, Y., Tang, W., Dou, H. B., Shan, J. H., & Hu, J. (2013). The superiority of allogeneic hematopoietic stem cell transplantation from unrelated donor over chemotherapy for adult patients with high-risk acute lymphoblastic leukemia in first remission. International Journal of Hematology, 98(5), 569-77.
Wang L, et al. The Superiority of Allogeneic Hematopoietic Stem Cell Transplantation From Unrelated Donor Over Chemotherapy for Adult Patients With High-risk Acute Lymphoblastic Leukemia in First Remission. Int J Hematol. 2013;98(5):569-77. PubMed PMID: 24078372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The superiority of allogeneic hematopoietic stem cell transplantation from unrelated donor over chemotherapy for adult patients with high-risk acute lymphoblastic leukemia in first remission. AU - Wang,Ling, AU - Wang,Ying, AU - Tang,Wei, AU - Dou,Han-Bo, AU - Shan,Jie-Hui, AU - Hu,Jiong, PY - 2012/10/16/received PY - 2013/09/11/accepted PY - 2013/09/09/revised PY - 2013/10/1/entrez PY - 2013/10/1/pubmed PY - 2014/7/26/medline SP - 569 EP - 77 JF - International journal of hematology JO - Int J Hematol VL - 98 IS - 5 N2 - For adult patients with acute lymphoblastic leukemia (ALL), allogeneic hematopoietic stem cell transplantation(allo-HSCT) from HLA-matched related donors(MSD) is recommended for standard and high-risk patients. The role of unrelated donor transplantation (URD) in first remission has not been fully determined. We sought to compare directly the outcome of URD allo-HSCT and chemotherapy in patients with high-risk ALL. In this single center retrospective analysis, we included 74 consecutive adult patients with high-risk ALL in first complete remission(CR) and without a sibling donor, in which 32 patients received URD allo-HSCT in CR1 with busulfan-cyclophosphamide preparation regimen and in vivo T-cell depletion with anti-T-lymphoglobulin (ATG). The remaining 42 patients received chemotherapy consolidation and maintenance only in first remission. With median follow-up of 18 months, in the URD allo-HSCT group, the relapse rate(RR) was 30.6 ± 11.4 % which was significantly lower than that of the chemotherapy group (80.5 ± 10.1 %,p < 0.001), while non-relapse mortality (NRM) was higher(16.4 ± 6.7 % vs. 0, p = 0.028). Overall, 3-year leukemia free survival (LFS) was superior in the URD allo-HSCT group compared to chemotherapy group (57.8 ± 10.6 vs.19.5 ± 10.5 %, p = 0.002), as was 3-year overall survival(OS, 63.5 ± 13.3 vs. 31.6 ± 10.6 %, p = 0.016). URDHSCT was the only factor associated with improved OS, LFS and reduced RR in multivariate analysis. Based on our data, URD allo-HSCT significantly reduced the relapse in high-risk ALL and the benefit translated into improvement in both LFS and OS. Prospective studies based on availability of HLA-matched URD are warranted to evaluate the precise role of URD transplantation in adult ALL. SN - 1865-3774 UR - https://www.unboundmedicine.com/medline/citation/24078372/The_superiority_of_allogeneic_hematopoietic_stem_cell_transplantation_from_unrelated_donor_over_chemotherapy_for_adult_patients_with_high_risk_acute_lymphoblastic_leukemia_in_first_remission_ L2 - https://dx.doi.org/10.1007/s12185-013-1442-5 DB - PRIME DP - Unbound Medicine ER -