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Allografting

Long-term results of allogeneic bone marrow transplantation for 108 adult patients with acute lymphoblastic leukemia: favorable outcome with BMT at first remission and HLA-matched unrelated donor

Bone Marrow Transplantation volume 40, pages 339–347 (2007)Cite this article

Abstract

We analyzed the outcome of 108 adult acute lymphoblastic leukemia patients undergoing allogeneic bone marrow transplantation (BMT). Philadelphia (Ph) chromosome occurred in 35.2% patients at diagnosis. Two-thirds of patients received allogeneic BMT in first complete remission (CR1) BMT. Salvage BMT was performed in 21 and 16 patients at second complete remission (CR2) and beyond CR2. Donors were human leukocyte antigen-identical siblings in 87 patients, and match-unrelated donors in 21 patients. Conditioning contained total body irradiation (TBI) in 92.6% patients. Overall survival (OS) for BMT at CR1 and BMT beyond CR1 were 46.2 and 20.3% at 15 years. Multivariate analyses (including age, sex, disease status, donor type, acute graft-versus-host disease (aGVHD), stem cell source, cytogenetics, grade 1/2 aGVHD and TBI-containing conditioning regimen) identified age<35, BMT at CR1 and grade 1/2 aGVHD as favorable factors for OS. Disease-free survival (DFS) for BMT at CR1 and beyond CR1 were 45.8 and 15.9% at 15 years, respectively, with BMT at CR1, age<35 and grade 1/2 aGVHD being favorable factors for DFS. Importantly, conventional adverse risk factors such as the Ph chromosome, B-cell phenotype and high leukocyte count were not associated with inferior survivals. In summary, the adverse impact of Ph chromosome, B-cell phenotype and high leukocyte count was overcome by allogeneic BMT. Matched unrelated donor transplantation appears promising.

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Acknowledgements

We thank Dr Nelson Chao, Professor of Medicine and Immunology & Chief, Division of Cellular Therapy/BMT, Duke University, Durham, USA, and Dr Richard Larson, Professor of Medicine, University of Chicago, for critical review of the manuscript. We are also grateful to Professor LC Chan and Dr Clarence Lam for the pathological diagnoses, and colleagues and nursing staff in the BMT team for the excellent patient care.

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  1. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China

    C S Chim, A K W Lie, R Liang, W Y Au & Y L Kwong

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Correspondence to C S Chim.

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Chim, C., Lie, A., Liang, R. et al. Long-term results of allogeneic bone marrow transplantation for 108 adult patients with acute lymphoblastic leukemia: favorable outcome with BMT at first remission and HLA-matched unrelated donor. Bone Marrow Transplant 40, 339–347 (2007). https://doi.org/10.1038/sj.bmt.1705734

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