title: Bone marrow transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia.
abstract: Between 1986 and 1995, 19 patients with Philadelphia chromosome-positive (Ph + ) acute lymphoblastic leukemia underwent 20 autologous (n = 9) or allogeneic (n = 11) blood or marrow transplant procedures in first (n = 12) or second (n = 3) remission, or in relapse (n = 5). Four patients died due to transplant-related causes, 11 relapsed at 3-39 months, one survives with disease which did not remit after transplant, and three are alive in continuous remission at 1, 26 and 65 months. Two of the relapsing patients are alive; one autografted patient after an allograft in second remission and one allografted patient after a donor leukocyte infusion. The projected overall survival is 37.5% at 3 years and 12.5% at 5 years. The 3-year probabilities of relapse and disease-free survival for autografted patients are 65.9% and 25.6% respectively, and for allografted patients, 63.4% and 21.8% respectively. The stage of the disease at the time of transplant or the type of transplant did not affect the outcome significantly, and late relapses beyond 3 years were seen after allogeneic as well as autologous transplantation. In our experience, the outcome of patients with Ph + acute lymphoblastic leukemia continues to be poor despite high-dose therapy due to high relapse rates, and the development of additional measures to enhance the antileukemic efficacy of bone marrow transplantation is necessary.
authors.affiliation: Leukaemia Unit, Royal Marsden Hospital, Surrey, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Dunlop
authors.forename: R
authors.initials: R
authors.lastname: Powles
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: J G
authors.initials: JG
authors.lastname: Treleaven
authors.forename: G J
authors.initials: GJ
authors.lastname: Swansbury
authors.forename: S
authors.initials: S
authors.lastname: Meller
authors.forename: C R
authors.initials: CR
authors.lastname: Pinkerton
authors.forename: C
authors.initials: C
authors.lastname: Horton
authors.forename: J
authors.initials: J
authors.lastname: Mehta
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous