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Allografting

Allogeneic SCT in refractory or relapsed adult ALL is effective without prior reinduction chemotherapy

Bone Marrow Transplantation volume 42, pages 791–798 (2008)Cite this article

Abstract

We present 60 patients with refractory (n=8) or relapsed (n=52) adult ALL who received allogeneic hematopoietic SCT (HSCT) with (n=41) or without (n=19) prior reinduction chemotherapy. In our center, omission of reinduction is recommended if a suitable donor is promptly available, tumor burden is moderate and disease features suggest a highly aggressive course. Overall survival (OS) of the whole cohort at 1, 2 and 5 years was 42, 33 and 28%, respectively. Leukemia-free survival at 1, 2 and 5 years was 37, 33 and 24%. Deaths were due to relapse (n=25), acute or chronic GVHD (n=7), infections (n=8) or toxicity (n=4). Interestingly, patients who did not receive reinduction before HSCT had better outcomes than patients who received reinduction with OS at 1, 2 and 5 years being 58 vs 34%, 47 vs 25% and 47 vs 18%, respectively (P=0.039). Importantly, even achievement of a second CR after reinduction was not associated with improved survival compared to patients directly proceeding to HSCT. We conclude that patients who undergo HSCT for refractory or relapsed ALL can achieve long-term survival. In selected patients, reinduction chemotherapy can be omitted if immediate HSCT is feasible.

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Acknowledgements

We thank Sabine Diehl for excellent data management.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany

    T H Terwey, G Massenkeil, I Tamm, P G Hemmati, S Neuburger, B Dörken & R Arnold

  2. Department of Internal Medicine, Hematology and Oncology, Ruhr-University, Bochum, Germany

    G Massenkeil

  3. Institute of Biostatistics and Clinical Epidemiology, Charité-University Medicine Berlin, Campus Mitte, Berlin, Germany

    P Martus

  4. Department of Hematology and Oncology, University of Frankfurt/Main, Frankfurt/Main, Germany

    D Hoelzer

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Correspondence to T H Terwey.

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Terwey, T., Massenkeil, G., Tamm, I. et al. Allogeneic SCT in refractory or relapsed adult ALL is effective without prior reinduction chemotherapy. Bone Marrow Transplant 42, 791–798 (2008). https://doi.org/10.1038/bmt.2008.258

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