title: Long-term outcomes of adults with acute lymphoblastic leukemia after autologous or unrelated donor bone marrow transplantation: a comparative analysis by the National Marrow Donor Program and Center for International Blood and Marrow Transplant Research.
abstract: For adults with high-risk or recurrent ALL who lack a suitable sibling donor, the decision between autologous (Auto) and unrelated donor (URD) hematopoietic stem cell transplantation (HSCT) is difficult due to variable risks of relapse and treatment-related mortality (TRM). We analysed data from two transplant registries to determine outcomes between Auto and URD HSCT for 260 adult ALL patients in first (CR1) or second (CR2) CR. All patients received a myeloablative conditioning regimen. The median follow-up was 77 (range 12-170) months. TRM at 1 year post transplant was significantly higher with URD HSCT; however, there were minimal differences in TRM according to disease status. Relapse was higher with Auto HSCT and was increased in patients transplanted in CR2. Five-year leukemia-free (37 vs 39%) and overall survival (OS) rates (38 vs 39%) were similar for Auto HSCT vs URD HSCT in CR1. There were trends favoring URD HSCT in CR2. The long-term follow-up in this analysis demonstrated that either Auto or URD HSCT could result in long-term leukaemia-free survival and OS for adult ALL patients. The optimal time (CR1 vs CR2) and technique to perform HSCT remains an important clinical question for adult ALL patients.
authors: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, 10 CenterDr ive, Building 10/CRC 4-3152, Bethesda, MD 20892, USA. mbishop@mail.nih.gov
authors: M R
authors: MR
authors: Bishop
authors: B R
authors: BR
authors: Logan
authors: S
authors: S
authors: Gandham
authors: B J
authors: BJ
authors: Bolwell
authors: J-Y
authors: JY
authors: Cahn
authors: H M
authors: HM
authors: Lazarus
authors: M R
authors: MR
authors: Litzow
authors: D I
authors: DI
authors: Marks
authors: P H
authors: PH
authors: Wiernik
authors: P L
authors: PL
authors: McCarthy
authors: J A
authors: JA
authors: Russell
authors: C B
authors: CB
authors: Miller
authors: J
authors: J
authors: Sierra
authors: G
authors: G
authors: Milone
authors: A
authors: A
authors: Keating
authors: F R
authors: FR
authors: Loberiza
authors: S
authors: S
authors: Giralt
authors: M M
authors: MM
authors: Horowitz
authors: D J
authors: DJ
authors: Weisdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome