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Allografting

Allogeneic hemopoietic stem cell transplants for patients with relapsed acute leukemia: long-term outcome

Bone Marrow Transplantation volume 39, pages 341–346 (2007)Cite this article

Abstract

We assessed the long-term outcome of patients with relapsed acute myeloid (n=86) or acute lymphoid leukemia (n=66), undergoing an allogeneic hemopoietic stem cell transplantation in our unit. The median blast count in the marrow was 30%. Conditioning regimen included total body irradiation (TBI) (10–12 Gy) in 115 patients. The donor was a matched donor (n=132) or a family mismatched donor (n=20). Twenty-two patients (15%) survive disease free, with a median follow-up of 14 years: 18 are off medications. The cumulative incidence of transplant related mortality is 40% and the cumulative incidence of relapse related death (RRD) is 45%. In multivariate analysis of survival, favorable predictors were chronic graft-versus-host disease (GvHD) (P=0.0003), donor other than family mismatched (P=0.02), donor age less than 34 years (P=0.02) and blast count less than 30% (P=0.07). Patients with all four favorable predictors had a 54% survival. In multivariate analysis of relapse, protective variables were the use of TBI (P=0.005) and cGvHD (P=0.01). This study confirms that a fraction of relapsed leukemias is cured with an allogeneic transplant: selection of patients with a blast count <30%, identification of young, human leukocyte antigen-matched donors and the use of total body radiation may significantly improve the outcome.

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References

  1. Thomas ED, Buckner CD, Banaji M, Clift RA, Fefer A, Flournoy N et al. One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation. Blood 1977; 49: 511–533.

    CAS  PubMed  Google Scholar 

  2. Sierra J, Storer B, Hansen JA, Martin PJ, Petersdorf EW, Woolfrey A et al. Unrelated donor marrow transplantation for acute myeloid leukemia: an update of the Seattle experience. Bone Marrow Transplant 2000; 26: 397–404.

    Article  CAS  Google Scholar 

  3. Petropoulos D, Worth LL, Mullen CA, Madden R, Mahajan A, Choroszy M et al. Total body irradiation, fludarabine, melphalan, and allogeneic hematopoietic stem cell transplantation for advanced pediatric hematologic malignancies. Bone Marrow Transplant 2006; 37: 463–467.

    Article  CAS  Google Scholar 

  4. Blume KG, Kopecky KJ, Henslee-Downey JP, Forman SJ, Stiff PJ, LeMaistre CF et al. A prospective randomized comparison of total body irradiation-etoposide versus busulfan-cyclophosphamide as preparatory regimens for bone marrow transplantation in patients with leukemia who were not in first remission: a Southwest Oncology Group study. Blood 1993; 81: 2187–2193.

    CAS  PubMed  Google Scholar 

  5. Schmid C, Schleuning M, Ledderose G, Tischer J, Kolb HJ . Sequential regimen of chemotherapy, reduced-intensity conditioning for allogeneic stem-cell transplantation, and prophylactic donor lymphocyte transfusion in high-risk acute myeloid leukemia and myelodysplastic syndrome. J Clin Oncol 2005; 23: 5675–5687.

    Article  Google Scholar 

  6. Matthews DC, Appelbaum FR, Eary JF, Fisher DR, Durack LD, Bush SA et al. Development of a marrow transplant regimen for acute leukemia using targeted hematopoietic irradiation delivered by 131I-labeled anti-CD45 antibody, combined with cyclophosphamide and total body irradiation. Blood 1995; 85: 1122–1131.

    CAS  PubMed  Google Scholar 

  7. Burke JM, Caron PC, Papadopoulos EB, Divgi CR, Sgouros G, Panageas KS et al. Cytoreduction with iodine-131-anti-CD33 antibodies before bone marrow transplantation for advanced myeloid leukemias. Bone Marrow Transplant 2003; 32: 549–556.

    Article  CAS  Google Scholar 

  8. Vitale V, Bacigalupo A, Van Lint MT, Frassoni F, Ricci G, Siracusa G et al. Fractionated total body irradiation in marrow transplantation for leukemia. Br J Haematol 1983; 55: 547.

    Article  CAS  Google Scholar 

  9. Bacigalupo A, van Lint MT, Valbonesi M, Lercari G, Carlier P, Lamparelli T et al. Thiotepa cyclophosphamide followed by granulocyte colony-stimulating factor mobilized allogeneic peripheral blood cells in adults with advanced leukemia. Blood 1996; 88: 353–357.

    CAS  PubMed  Google Scholar 

  10. Bacigalupo A, Mordini N, Pitto A, Piaggio G, Podestà M, Benvenuto F et al. Transplantation of HLA-mismatched CD34+ selected cells in patients with advanced malignancies: severe immunodeficiency and related complications. Br J Haematol 1997; 98: 760–766.

    Article  CAS  Google Scholar 

  11. Bacigalupo A, Lamparelli T, Gualandi F, Bregante S, Raiola AM, Di Grazia C et al. Prophylactic antithymocyte globulin reduces the risk of chronic graft-versus-host disease in alternative-donor bone marrow transplants. Biol Blood Marrow Tr 2002; 8: 656–661.

    Article  CAS  Google Scholar 

  12. Bacigalupo A, Sormani MP, Lamparelli T, Gualandi F, Occhini D, Bregante S et al. Reducing transplant related mortalità after allogeneic hemopoietic stem cell transplantation. Haematologica 2004; 89: 1238–1247.

    PubMed  Google Scholar 

  13. Clift RA, Buckner CD, Appelbaum FR, Bearman SI, Petersen FB, Fisher LD et al. Allogeneic marrow transplantation in patients with acute myeloid leukemia in first remission: a randomized trial of two irradiation regimens. Blood 1990; 76: 1867–1871.

    CAS  PubMed  Google Scholar 

  14. Socie G, Clift RA, Blaise D, Devergie A, Ringden O, Martin P et al. Busulfan plus cyclophosphamide compared with total-body irradiation plus cyclophosphamide before marrow transplantation for myeloid leukemia: long-term follow-up of 4 randomized studies. Blood 2001; 98: 3569–3574.

    Article  CAS  Google Scholar 

  15. Bacigalupo A, van Lint MT, Occhini D, Gualandi F, Lamperelli T, Sogno G et al. Increased risk of leukemia relapse with high-dose cyclosporine A after allogeneic marrow transplantation for acute leukemia. Blood 1991; 77: 1423–1428.

    CAS  PubMed  Google Scholar 

  16. Locatelli F, Zecca M, Rondelli R, Bonetti F, Dini G, Prete A et al. Graft versus host disease prophylaxis with low-dose cyclosporine-A reduces the risk of relapse in children with acute leukemia given HLA-identical sibling bone marrow transplantation: results of a randomized trial. Blood 2000; 95: 1572–1579.

    CAS  PubMed  Google Scholar 

  17. Bacigalupo A, Lamparelli T, Gualandi F, Bregante S, Raiola AM, Di Grazia C et al. Increased risk of leukemia relapse with high-dose cyclosporine A after allogeneic marrow transplantation for acute leukemia: a 10 year follow up of a randomized study. Blood 2001; 98: 3174–3175.

    Article  CAS  Google Scholar 

  18. Rocha V, Cornish J, Sievers EL, Filipovich A, Locatelli F, Peters C et al. Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia. Blood 2001; 97: 2962–2971.

    Article  CAS  Google Scholar 

  19. Barker JN, Weisdorf DJ, DeFor TE, Blazar BR, McGlave PB, Miller JS et al. Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy. Blood 2005; 105: 1343–1347.

    Article  CAS  Google Scholar 

  20. Magro E, Regidor C, Cabrera R, Sanjuan I, Fores R, Garcia-Marco JA et al. Early hematopoietic recovery after single unit unrelated cord blood transplantation in adults supported by co-infusion of mobilized stem cells from a third party donor. Haematologica 2006; 91: 640–648.

    PubMed  Google Scholar 

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Acknowledgements

This work was supported by Associazione Italiana Ricerca contro il Cancro (AIRC) Milano grant to AB and Fondazione Cassa Risparmio Genova e Imperia (CARIGE). The great work of our nursing staff is gratefully acknowledged.

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Authors and Affiliations

  1. Divisione di Ematologia 2, Ospedale San Martino, Genova, Italy

    A Bacigalupo, T Lamparelli, F Gualandi, D Occhini, S Bregante, A M Raiola, A Ibatici, C di Grazia, A Dominietto, G Piaggio, M Podesta, B Bruno, A Lombardi, F Frassoni, C Viscoli, N Sacchi & M T Van Lint

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  1. A Bacigalupo
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  2. T Lamparelli
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  3. F Gualandi
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  4. D Occhini
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  5. S Bregante
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  6. A M Raiola
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  7. A Ibatici
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  8. C di Grazia
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  14. F Frassoni
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Correspondence to A Bacigalupo.

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Bacigalupo, A., Lamparelli, T., Gualandi, F. et al. Allogeneic hemopoietic stem cell transplants for patients with relapsed acute leukemia: long-term outcome. Bone Marrow Transplant 39, 341–346 (2007). https://doi.org/10.1038/sj.bmt.1705594

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