The role of allogeneic bone marrow transplantation in the treatment of high-risk acute lymphocytic leukemia in adults.
Studies in the last decade show that most adults with acute lymphocytic leukemia (ALL) can achieve remission with intensive induction chemotherapy. Depending on the risk factors present at diagnosis in an individual patient, continued remissions range from less than 10% to more than 50%. The following factors have been shown to be predictive of relapse: high white cell count at diagnosis, age beyond 30, extramedullary disease at presentation, unfavorable chromosomal translocations, time longer than 6 weeks to enter remission, and use of less intensive chemotherapy for induction. Studies have been conducted to determine whether allogeneic bone marrow transplantation (BMT) could improve the outcome for patients with high-risk ALL when performed during first remission. These studies have shown that these patients have a 40% to 60% chance of disease-free survival. The current recommended strategy for patients with high-risk ALL in first remission is to undergo bone marrow transplantation prior to relapse. For those in second and subsequent remissions or those who do not achieve remission, allogeneic BMT still offers the best chance for cure of the disease.
Forman
S J
SJ
Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA 91010-3012, USA.
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000628:therapy*; D012074:Remission Induction; D018570:Risk Assessment; D014178:Translocation, Genetic; D014184:Transplantation, Homologous
D000970:Antineoplastic Agents