1. ¹Department of Transfusion Medicine, Metropolitan Fuchu Hospital, Tokyo, Japan
2. ²Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan
3. ³Department of Cell Therapy & Transplantation Medicine, University of Tokyo, Tokyo, Japan
4. ⁴Department of Hematology, Toranomon Hospital, Tokyo, Japan
5. ⁵Department of Internal Medicine, Japanese Red Cross Nagoya First Hospital, Japan
6. ⁶First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
7. ⁷Department of Hematology, Matsushita Memorial Hospital, Osaka, Japan
8. ⁸Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
9. ⁹Department of Internal Medicine, Kurashiki Central Hospital, Okayama, Japan
10. ¹⁰Department of Clinical Hematology and Clinical Diagnostics, Graduate School of Medicine, Osaka City University, Osaka, Japan
11. ¹¹Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
12. ¹²Department of Hematology and Oncology, Shimane Prefectural Central Hospital, Shimane, Japan
13. ¹³Department of Internal Medicine, Kumamoto National Hospital, Kumamoto, Japan
14. ¹⁴Department of Hematology, Tenri Hospital, Osaka, Japan

Correspondence: Dr M Kami, Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. E-mail: mkami@ncc.go.jp

Received 7 June 2004; Accepted 5 October 2004; Published online 31 January 2005.

Abstract

Efficacy of reduced-intensity stem-cell transplantation (RIST) for acute lymphoblastic leukemia (ALL) was investigated in 33 patients (median age, 55 years). RIST sources comprised 20 HLA-identical related donors, five HLA-mismatched related, and eight unrelated donors. Six patients had undergone previous transplantation. Disease status at RIST was first remission (n=13), second remission (n=6), and induction failure or relapse (n=14). All patients tolerated preparatory regimens and achieved neutrophil engraftment (median, day 12.5). Acute and chronic graft-versus-host disease (GVHD) developed in 45 and 64%, respectively. Six patients received donor lymphocyte infusion (DLI), for prophylaxis (n=1) or treatment of recurrent ALL (n=5). Nine patients died of transplant-related mortality, with six deaths due to GVHD. The median follow-up of surviving patients was 11.6 months (range, 3.5–37.3 months). The 1-year relapse-free and overall survival rates were 29.8 and 39.6%, respectively. Of the 14 patients transplanted in relapse, five remained relapse free for longer than 6 months. Cumulative rates of progression and progression-free mortality at 3 years were 50.9 and 30.4%, respectively. These findings suggest the presence of a graft-versus-leukemia effect for ALL. RIST for ALL is worth considering for further evaluation.