title: Monoclonal antibody-purged autologous bone marrow transplantation in adults with acute lymphoblastic leukemia at high risk of relapse.
abstract: The prognosis for adults with B lineage ALL who have relapsed after an initial remission is poor. High-dose chemoradiotherapy followed by autologous BMT can induce prolonged clinical remissions in some children with recurrent ALL. In this study, we evaluated the efficacy of autologous BMT in adults. Autologous marrow was treated in vitro with J5 and J2 monoclonal antibodies (CD10/CD9) plus rabbit complement to purge residual ALL cells. Twenty-two adults with B lineage ALL were treated with high-dose chemoradiotherapy followed by infusion of J2/J5 purged autologous BM. The median age was 28 years (range 18-54 years). Twenty-one of 22 patients had experienced at least one relapse prior to BMT. All patients achieved complete hematologic engraftment. Disease-free survival (DFS) in this cohort of patients was 20%, with all survivors alive and free of disease between 2.5 and 7.5 years post-BMT. Age at the time of BMT was an important prognostic factor, with patients < 28 years old faring much better than older individuals (DFS, 45% vs 0%, p = 0.01). Our experience suggests that high-dose chemoradiotherapy followed by infusion of J2/J5 purged autologous marrow is as efficacious in young adults as it is in children and is a reasonable alternative for patients who lack HLA-matched donors. Results in older adults are poor, however, and demonstrate the need for more effective transplant strategies in these individuals.
authors.affiliation: Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA 02115.
authors.forename: R J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: D C
authors.initials: DC
authors.lastname: Roy
authors.forename: R
authors.initials: R
authors.lastname: Gonin
authors.forename: C
authors.initials: C
authors.lastname: Murray
authors.forename: K C
authors.initials: KC
authors.lastname: Anderson
authors.forename: A S
authors.initials: AS
authors.lastname: Freedman
authors.forename: S N
authors.initials: SN
authors.lastname: Rabinowe
authors.forename: M J
authors.initials: MJ
authors.lastname: Robertson
authors.forename: N
authors.initials: N
authors.lastname: Spector
authors.forename: K
authors.initials: K
authors.lastname: Pesek
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal; D000912:Antibodies, Neoplasm; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation / Q000401:mortality; D002051:Burkitt Lymphoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D014411:Neoplastic Stem Cells / Q000276:immunology* / Q000473:pathology; D015260:Neprilysin / Q000276:immunology*; D012074:Remission Induction; D012306:Risk; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D000911:Antibodies, Monoclonal; D000912:Antibodies, Neoplasm; D003520:Cyclophosphamide; D015260:Neprilysin