Allogeneic hemopoietic stem cell transplants for patients with relapsed acute leukemia: long-term outcome.
We assessed the long-term outcome of patients with relapsed acute myeloid (n=86) or acute lymphoid leukemia (n=66), undergoing an allogeneic hemopoietic stem cell transplantation in our unit. The median blast count in the marrow was 30%. Conditioning regimen included total body irradiation (TBI) (10-12 Gy) in 115 patients. The donor was a matched donor (n=132) or a family mismatched donor (n=20). Twenty-two patients (15%) survive disease free, with a median follow-up of 14 years: 18 are off medications. The cumulative incidence of transplant related mortality is 40% and the cumulative incidence of relapse related death (RRD) is 45%. In multivariate analysis of survival, favorable predictors were chronic graft-versus-host disease (GvHD) (P=0.0003), donor other than family mismatched (P=0.02), donor age less than 34 years (P=0.02) and blast count less than 30% (P=0.07). Patients with all four favorable predictors had a 54% survival. In multivariate analysis of relapse, protective variables were the use of TBI (P=0.005) and cGvHD (P=0.01). This study confirms that a fraction of relapsed leukemias is cured with an allogeneic transplant: selection of patients with a blast count <30%, identification of young, human leukocyte antigen-matched donors and the use of total body radiation may significantly improve the outcome.
Bacigalupo
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Divisione di Ematologia 2, Ospedale San Martino, Genova, Italy. andrea.bacigalupo@hsanmartino.it
Lamparelli
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T
Gualandi
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F
Occhini
D
D
Bregante
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S
Raiola
A M
AM
Ibatici
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A
di Grazia
C
C
Dominietto
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A
Piaggio
G
G
Podesta
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M
Bruno
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B
Lombardi
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A
Frassoni
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F
Viscoli
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C
Sacchi
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N
Van Lint
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MT
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001856:Bone Marrow Examination; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D007951:Leukemia, Myeloid / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D018579:Patient Selection; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D011379:Prognosis; D017741:Survivors; D014184:Transplantation, Homologous