title: The role of allogeneic bone marrow transplantation in adult patients below the age of 55 years with acute lymphoblastic leukemia in first complete remission: a donor vs no donor comparison.
abstract: The role of allogeneic bone marrow transplantation (alloBMT) in adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) remains controversial. At our institution, the policy is to offer alloBMT to ALL patients in CR1 up to the age of 55 years if a related donor is available. In addition, unrelated donor transplants are offered to patients with Philadelphia (Ph+) ALL. We report the results on 92 patients with ALL treated according to this policy from September 1992 to October 2001. Of the 87 patients achieving CR1, the comparison of patients with (n=48) or without donors (n=39) was done using an intention-to-treat approach. Of the 48 patients with donors (39 related and nine unrelated), 35 (73%) received alloBMT in CR1. No significant difference in 3-year event-free survival (EFS) (40 vs 39%, P=0.74) or overall survival (OS) (46 vs 58%, P=0.41) was seen in 'donor' vs 'no-donor' groups. For Ph+ patients, 3-year EFS and OS in 'donor' group were 46 and 57%, respectively, none of the patients in 'no-donor' group survived beyond 3 years. With our treatment strategy, 3-year OS of Ph+ patients was equivalent to Ph-negative (Ph-) patients (51 vs 52%, P=0.77). In conclusion, our data show that the policy of performing alloBMT if a sibling donor is available has not resulted in better outcome in Ph- patients.
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Gupta
authors.forename: Q-L
authors.initials: QL
authors.lastname: Yi
authors.forename: J
authors.initials: J
authors.lastname: Brandwein
authors.forename: M D
authors.initials: MD
authors.lastname: Minden
authors.forename: A C
authors.initials: AC
authors.lastname: Schuh
authors.forename: R A
authors.initials: RA
authors.lastname: Wells
authors.forename: K
authors.initials: K
authors.lastname: Chun
authors.forename: S
authors.initials: S
authors.lastname: Kamel-Reid
authors.forename: R
authors.initials: R
authors.lastname: Tsang
authors.forename: A
authors.initials: A
authors.lastname: Daly
authors.forename: T
authors.initials: T
authors.lastname: Kiss
authors.forename: J H
authors.initials: JH
authors.lastname: Lipton
authors.forename: H A
authors.initials: HA
authors.lastname: Messner
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000401:mortality*; D020732:Cytogenetic Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents