title: Allogeneic stem cell transplantation in first complete remission enhances graft-versus-leukemia effect in adults with acute lymphoblastic leukemia: antileukemic activity of chronic graft-versus-host disease.
abstract: The aim of the present study was to identify graft-versus-leukemia effects and the factors that affect outcome in 201 adults with acute lymphobalstic leukemia who received myeloablative allogeneic stem cell transplantation from matched sibling or unrelated donors (1995-2004). One hundred seventy-eight (88.6%) of these patients had high-risk criteria, and 151 (75.1%) patients were transplanted in first complete remission (CR). All patients received unmodified stem cell grafts (185 bone marrow and 16 peripheral blood) following total- body irradiation-containing myeloablative preparations. Graft-versus-host disease (GVHD) prophylaxis was uniformly attempted by administering calcineurin inhibitor plus methotrexate. After a median follow-up of 63 months (range: 25+ to 139+ months) for surviving transplants, disease-free survival at 5 years was 47.8% for all patients and 60.3% for patients in the first CR. No difference in transplantation outcome was observed between sibling and unrelated transplants in the first CR. The most powerful predictive factor affecting transplantation outcome was disease status at transplantation (the first CR versus beyond the first CR, P<.001). Chronic GVHD (cGVHD), especially limited type, was also found to have a significant antileukemic effect. Interestingly, the influence of cGVHD on relapse risk was prominent in patients with chromosomal translocations or normal cytogenetics.
authors: Catholic Hematopoietic Stem Cell Transplantation Center, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea. leeseok@catholic.ac.kr
authors: Seok
authors: S
authors: Lee
authors: Byung-Sik
authors: BS
authors: Cho
authors: Sung-Yong
authors: SY
authors: Kim
authors: Su-Mi
authors: SM
authors: Choi
authors: Dong-Gun
authors: DG
authors: Lee
authors: Ki-Seong
authors: KS
authors: Eom
authors: Yoo-Jin
authors: YJ
authors: Kim
authors: Hee-Je
authors: HJ
authors: Kim
authors: Chang-Ki
authors: CK
authors: Min
authors: Seok-Goo
authors: SG
authors: Cho
authors: Dong-Wook
authors: DW
authors: Kim
authors: Jong-Wook
authors: JW
authors: Lee
authors: Woo-Sung
authors: WS
authors: Min
authors: Wan-Shik
authors: WS
authors: Shin
authors: Chun-Choo
authors: CC
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy*; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011292:Premedication; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D014019:Tissue Donors; D014178:Translocation, Genetic; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D019653:Myeloablative Agonists