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.
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.
Lee
Seok
S
Catholic Hematopoietic Stem Cell Transplantation Center, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea. leeseok@catholic.ac.kr
Cho
Byung-Sik
BS
Kim
Sung-Yong
SY
Choi
Su-Mi
SM
Lee
Dong-Gun
DG
Eom
Ki-Seong
KS
Kim
Yoo-Jin
YJ
Kim
Hee-Je
HJ
Min
Chang-Ki
CK
Cho
Seok-Goo
SG
Kim
Dong-Wook
DW
Lee
Jong-Wook
JW
Min
Woo-Sung
WS
Shin
Wan-Shik
WS
Kim
Chun-Choo
CC
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
D019653:Myeloablative Agonists