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Acute Lymphoblastic Leukemia

The role of allogeneic bone marrow transplantation in adult patients below the age of 55 years with acute lymphoblastic leukemia in first complete remission: a donor vs no donor comparison

Summary:

The role of allogeneic bone marrow transplantation (alloBMT) in adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) remains controversial. At our institution, the policy is to offer alloBMT to ALL patients in CR1 up to the age of 55 years if a related donor is available. In addition, unrelated donor transplants are offered to patients with Philadelphia (Ph+) ALL. We report the results on 92 patients with ALL treated according to this policy from September 1992 to October 2001. Of the 87 patients achieving CR1, the comparison of patients with (n=48) or without donors (n=39) was done using an intention-to-treat approach. Of the 48 patients with donors (39 related and nine unrelated), 35 (73%) received alloBMT in CR1. No significant difference in 3-year event-free survival (EFS) (40 vs 39%, P=0.74) or overall survival (OS) (46 vs 58%, P=0.41) was seen in ‘donor’ vs ‘no-donor’ groups. For Ph+ patients, 3-year EFS and OS in ‘donor’ group were 46 and 57%, respectively, none of the patients in ‘no-donor’ group survived beyond 3 years. With our treatment strategy, 3-year OS of Ph+ patients was equivalent to Ph-negative (Ph−) patients (51 vs 52%, P=0.77). In conclusion, our data show that the policy of performing alloBMT if a sibling donor is available has not resulted in better outcome in Ph− patients.

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Acknowledgements

We thank Dawn Gilmour and Natasha Kotchetkova in the Leukemia and BMT registries for their assistance with data collection. We also thank the inpatient and outpatient nursing staff of Leukemia and BMT service for the excellent care provided to the patients.

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Correspondence to H A Messner.

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Gupta, V., Yi, QL., Brandwein, J. et al. The role of allogeneic bone marrow transplantation in adult patients below the age of 55 years with acute lymphoblastic leukemia in first complete remission: a donor vs no donor comparison. Bone Marrow Transplant 33, 397–404 (2004). https://doi.org/10.1038/sj.bmt.1704368

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Keywords

  • acute lymphoblastic leukemia
  • treatment
  • chemotherapy

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