title: Factors associated with outcome after unrelated marrow transplantation for treatment of acute lymphoblastic leukemia in children.
abstract: Acute lymphoblastic leukemia (ALL) is the most common indication for transplantation of marrow from unrelated donors in children. We analyzed results of this procedure in children with ALL treated according to a standard protocol to determine risk factors for outcome. From January 1987 to 1999, 88 consecutively seen patients with ALL who were younger than 18 years received a marrow transplant from an HLA-matched (n = 56) or partly matched (n = 32) unrelated donor during first complete remission (CR1; n = 10), second remission (CR2; n = 34), third remission (CR3; n = 10), or relapse (n = 34). Patients received cyclophosphamide and fractionated total-body irradiation as conditioning treatment and were given methotrexate and cyclosporine for graft-versus-host disease (GVHD) prophylaxis. Three-year rates of leukemia-free survival (LFS) according to phase of disease were 70% for CR1, 46% for CR2, 20% for CR3, and 9% for relapse (P <.0001). Three-year cumulative relapse rates were 10%, 33%, 20%, and 50%, respectively, and 3-year cumulative rates of death not due to relapse were 20%, 22%, 60%, and 41%, respectively, for patients with CR1, CR2, CR3, and relapse. Grades III to IV acute GVHD occurred in 43% of patients given HLA-matched transplants and in 59% given partly matched transplants (P =.10); clinical extensive chronic GVHD occurred in 32% and 38%, respectively (P =.23). LFS rates were lower in patients with advanced disease (P <.0001), age 10 years or older (P =.002), or short duration of CR1 (P =.007). Thus, in addition to phase of disease, age and duration of CR1 were predictors of outcome after unrelated-donor transplantation for treatment of ALL in children. Outcome was particularly favorable in younger patients with early phases of the disease.
authors.affiliation: Pediatric Transplantation, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109-1024, USA. awoolfre@fhcrc.org
authors.forename: Ann E
authors.initials: AE
authors.lastname: Woolfrey
authors.forename: Claudio
authors.initials: C
authors.lastname: Anasetti
authors.forename: Barry
authors.initials: B
authors.lastname: Storer
authors.forename: Kristine
authors.initials: K
authors.lastname: Doney
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Milner
authors.forename: Eric L
authors.initials: EL
authors.lastname: Sievers
authors.forename: Paul
authors.initials: P
authors.lastname: Carpenter
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Effie
authors.initials: E
authors.lastname: Petersdorf
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: John A
authors.initials: JA
authors.lastname: Hansen
authors.forename: Jean E
authors.initials: JE
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000401:mortality / Q000592:standards; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D000970:Antineoplastic Agents