title: Allogeneic hemopoietic stem cell transplants for patients with relapsed acute leukemia: long-term outcome.
abstract: 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.
authors.affiliation: Divisione di Ematologia 2, Ospedale San Martino, Genova, Italy. andrea.bacigalupo@hsanmartino.it
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: T
authors.initials: T
authors.lastname: Lamparelli
authors.forename: F
authors.initials: F
authors.lastname: Gualandi
authors.forename: D
authors.initials: D
authors.lastname: Occhini
authors.forename: S
authors.initials: S
authors.lastname: Bregante
authors.forename: A M
authors.initials: AM
authors.lastname: Raiola
authors.forename: A
authors.initials: A
authors.lastname: Ibatici
authors.forename: C
authors.initials: C
authors.lastname: di Grazia
authors.forename: A
authors.initials: A
authors.lastname: Dominietto
authors.forename: G
authors.initials: G
authors.lastname: Piaggio
authors.forename: M
authors.initials: M
authors.lastname: Podesta
authors.forename: B
authors.initials: B
authors.lastname: Bruno
authors.forename: A
authors.initials: A
authors.lastname: Lombardi
authors.forename: F
authors.initials: F
authors.lastname: Frassoni
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
authors.forename: N
authors.initials: N
authors.lastname: Sacchi
authors.forename: M T
authors.initials: MT
authors.lastname: Van Lint
mesh_terms: 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