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Clinical Results

Autologous and allogeneic stem cell transplantation in adult ALL: the Swedish Adult ALL Group experience

Bone Marrow Transplantation volume 35, pages 1141–1148 (2005)Cite this article

Summary:

Adult patients with acute lymphoblastic leukaemia (ALL) have been treated according to national protocols in Sweden since 1986. Stem cell transplantation (SCT) has been recommended in first remission for patients with risk factors for relapse, and for standard risk patients only after relapse. In this retrospective study, the results of autologous and allogeneic SCT in these populations were evaluated. In total, 187 patients with a median age of 34 years (17–66 years) underwent SCT. The 5-year disease-free survival (DFS), for all patients, was 26% (Confidence intervals (CI) 20–32%). The 5-year DFS was higher for patients transplanted in first remission 32% (CI 24–40%) compared to 14% (CI 5–23%; P<0.0001) in patients transplanted beyond first remission. No significant differences in DFS (P=0.06) were determined between autologous, related donor and unrelated donor SCT in the whole cohort. A lower relapse rate was counterbalanced by higher treatment-related mortality in patients undergoing allogeneic SCT. In Philadelphia-positive ALL, allogeneic SCT was superior to autologous SCT, with a 5-year DFS of 30% (CI 12–47%) vs 0% (P=0.04). Limited chronic graft-versus-host-disease (GVHD) was associated with an improved DFS of 53% (CI 38–69%) compared to no chronic GVHD of 22% (CI 10–36%; P=0.0008), indicating a clinically important graft-versus-leukaemia effect.

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Acknowledgements

We thank biostatistican Niclas Eriksson, Uppsala Clinical Research Center for statistical advice and Karin Hellström, the Oncology Centre in the Uppsala/Örebro region for data collection.

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Authors and Affiliations

  1. Department of Haematology, University Hospital, Uppsala, Sweden

    H Hallböök & B Smedmyr

  2. Department of Haematology, Karolinska University Hospital, Huddinge, Sweden

    H Hägglund

  3. Haematology Section, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden

    D Stockelberg

  4. Department of Haematology, University Hospital, Lund, Sweden

    P-G Nilsson & K Karlsson

  5. Department of Haematology, University Hospital, Linköping, Sweden

    K Karlsson & M Linderholm

  6. Department of Haematology, Karolinska University Hospital, Solna, Sweden

    M Björkholm & M Linderholm

  7. Division of Haematology, Department of Medicine, University Hospital, Umeå, Sweden

    A Wahlin

  8. Division of Haematology, Department of Medicine, University Hospital, Örebro, Sweden

    O Linder

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  1. H Hallböök
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for the Swedish Adult ALL Group

Corresponding author

Correspondence to H Hallböök.

Appendix A

Appendix A

Participating centres in the Swedish Adult ALL Group:

Department of Haematology, Karolinska University Hospital, Huddinge; Department of Haematology, Karolinska University Hospital, Solna; Department of Haematology, University Hospital, Linköping; Department of Haematology, University Hospital, Lund, Section of Haematology and Coagulation, Department of Medicine, Malmö University Hospital, Malmö; Haematology Section, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg; Department of Medicine, Division of Haematology, University Hospital, Umeå; Department of Haematology, University Hospital, Uppsala; Department of Medicine, Division of Haematology, University Hospital, Örebro, Sweden.

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Hallböök, H., Hägglund, H., Stockelberg, D. et al. Autologous and allogeneic stem cell transplantation in adult ALL: the Swedish Adult ALL Group experience. Bone Marrow Transplant 35, 1141–1148 (2005). https://doi.org/10.1038/sj.bmt.1704974

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  • DOI: https://doi.org/10.1038/sj.bmt.1704974

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