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Autologous hematopoietic cell transplantation for high-risk ALL

Bone Marrow Transplantation volume 46, pages 460–461 (2011)Cite this article

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The role of autologous hematopoietic cell transplantation (AHCT) in the treatment of ALL remains unclear.1 Several phase III studies have failed to demonstrate the superiority of AHCT over conventional chemotherapy.2, 3, 4, 5 We hypothesized that an intensified approach might improve the outcomes of AHCT for adults with ALL. We used an intensive consolidation treatment with high-dose cytarabine and etoposide that has been used in AHCT for AML and has produced excellent hematopoietic cell mobilization.6 The aims of this consolidation therapy were to decrease leukemia cell burden in the patient, produce good progenitor cell mobilization and provide in vivo purging of the graft. We performed ex vivo purging of the graft with a combination of monoclonal antibodies and complement in order to further reduce leukemic contamination.7 We developed an intensified preparative regimen that would be unsuitable for allogeneic transplantation, but that we thought would be appropriate for autologous transplantation, based on the high-dose fractionated TBI (FTBI) plus etoposide program developed at the City of Hope National Medical Center,8 by adding CY 100 mg/kg. In order to ascertain the efficacy of the overall approach in a phase II study, we enrolled only high-risk patients who would be expected to have a very poor outcome if treated with chemotherapy alone and in whom no allogeneic hematopoietic cell donor was available or AHCT was not appropriate.

Each participant signed an institutional review board-approved, protocol-specific informed consent document in accordance with the federal and institutional guidelines. Patients between ages 16 and 60 were eligible for study entry in second remission, or in first remission of ALL if they were at high risk based on one or more of the following criteria: B-lineage disease with WBC count at diagnosis >30 000/mcl; high-risk cytogenetics, including t(9;22), t(4;11), other 11q23 abnormalities, or monosomy 7; or failure to achieve CR after a first course of induction chemotherapy.

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Authors and Affiliations

  1. University of California San Francisco, San Francisco, CA, USA

    C Linker, L Damon & T Martin

  2. Stanford University Medical Center, Palo Alto, CA, USA

    K Blume, J Wolf & R Negrin

  3. City of Hope National Medical Center, Duarte, CA, USA

    S Forman & D Snyder

  4. Alta Bates Medical Center, Berkeley, CA, USA

    J Wolf

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  1. C Linker
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  2. L Damon
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  3. T Martin
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  4. K Blume
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  7. J Wolf
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  8. R Negrin
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Correspondence to C Linker.

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Linker, C., Damon, L., Martin, T. et al. Autologous hematopoietic cell transplantation for high-risk ALL. Bone Marrow Transplant 46, 460–461 (2011). https://doi.org/10.1038/bmt.2010.125

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