title: Factors affecting the outcome of stem cell transplantation from unrelated donors for childhood acute lymphoblastic leukemia in third remission.
abstract: Between July 1990 and March 2002, 35 consecutive children with ALL in third complete remission (CR3) underwent stem cell transplantation (SCT) from unrelated donors (UD). All patients received CAMPATH-1M 5-20 mg daily for 5 days. Grafts were T-cell depleted in 30 patients, 29 by CAMPATH antibodies and one by CD34 selection. Median follow-up was 3.8 years (0.3-9.3). Event-free survival (EFS) at 3 years was 35% (SE 8%); relapse rate and transplant-related mortality (TRM) at 3 years was 42 and 23%. Short first complete remission (CR1) <2.5 years was associated with lower EFS (P=0.001), higher TRM (P=0.019) and higher relapse rate (P=0.023). Short second complete remission (CR2) <2.5 years was associated with lower EFS (P=0.003) and higher TRM (0.009). Higher relapse rate and lower EFS were associated with isolated first extramedullary relapse (P=0.019, 0.012). There was no significant difference in outcome between mismatched unrelated donor stem cell transplantation (MMUD-SCT) and matched unrelated donor stem cell transplantation (UD-SCT). We conclude that UD-SCT is an effective treatment of ALL in CR3. The outcome remains limited by TRM and a high relapse rate. Short duration of CR1 and of CR2 and extramedullary site at first relapse are particularly adverse. MMUD should also be considered in high-risk patients, since the outcome of MMUD appears similar to MUD.
authors.affiliation: Department of Pediatrics, Hematology Oncology Division, University of Utah, Primary Children's Medical Center, 100 N. Medical Drive Ste. 1400, Salt Lake City, UT 84113, USA. pczafify@ihc.com
authors.forename: Z
authors.initials: Z
authors.lastname: Afify
authors.forename: L
authors.initials: L
authors.lastname: Hunt
authors.forename: A
authors.initials: A
authors.lastname: Green
authors.forename: M
authors.initials: M
authors.lastname: Guttridge
authors.forename: J
authors.initials: J
authors.lastname: Cornish
authors.forename: A
authors.initials: A
authors.lastname: Oakhill
mesh_terms: D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D018952:Antigens, CD34 / Q000096:biosynthesis; D016026:Bone Marrow Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D011183:Postoperative Complications; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000379:methods*; D013601:T-Lymphocytes / Q000166:cytology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D018952:Antigens, CD34; D000074323:Alemtuzumab