Unrelated donor transplants in adults with Philadelphia-negative acute lymphoblastic leukemia in first complete remission.
We report the retrospective outcomes of unrelated donor (URD) transplants in 169 patients with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) who received transplants between 1995 and 2004. Median age was 33 years (range, 16-59 years). A total of 50% had a white blood cell count (WBC) more than 30 x 10(9)/L, 18% extramedullary disease, 42% achieved CR more than 8 weeks from diagnosis, 25% had adverse cytogenetics, and 19% had T-cell leukemia. A total of 41% were HLA well-matched, 41% partially matched with their donors, and 18% were HLA-mismatched. At 54-month median follow-up, incidences of acute grade 2-IV, III to IV, and chronic graft-versus-host disease were 50%, 25%, and 43%, respectively. Five-year treatment-related mortality (TRM), relapse, and overall survival were 42%, 20%, and 39%, respectively. In multivariate analyses, TRM was significantly higher with HLA-mismatched donors and T-cell depletion. Relapse risk was higher if the diagnostic WBC was more than 100 x 10(9)/L. Factors associated with poorer survival included WBC more than 100 x 10(9)/L, more than 8 weeks to CR1, cytomegalovirus seropositivity, HLA mismatching, and T-cell depletion. Nearly 40% of adults with ALL in CR1 survive 5 years after URD transplantation. Relapse risks were modest; TRM is the major cause of treatment failure. Selecting closely HLA-matched URD and reducing TRM should improve results.
Marks
David I
DI
Adult Blood and Marrow Transplantation (BMT) Unit, United Bristol Healthcare Trust, Bristol, United Kingdom;
Pérez
Waleska S
WS
He
Wensheng
W
Zhang
Mei-Jie
MJ
Bishop
Michael R
MR
Bolwell
Brian J
BJ
Bredeson
Christopher N
CN
Copelan
Edward A
EA
Gale
Robert Peter
RP
Gupta
Vikas
V
Hale
Gregory A
GA
Isola
Luis M
LM
Jakubowski
Ann A
AA
Keating
Armand
A
Klumpp
Thomas R
TR
Lazarus
Hillard M
HM
Liesveld
Jane L
JL
Maziarz
Richard T
RT
McCarthy
Philip L
PL
Sabloff
Mitchell
M
Schiller
Gary
G
Sierra
Jorge
J
Tallman
Martin S
MS
Waller
Edmund K
EK
Wiernik
Peter H
PH
Weisdorf
Daniel J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors