title: Reduced-intensity conditioning followed by peripheral blood stem cell transplantation for adult patients with high-risk acute lymphoblastic leukemia.
abstract: Acute lymphoblastic leukemia (ALL) with high-risk features has a poor prognosis in adults despite aggressive chemotherapy. Reduced-intensity conditioning (RIC) is a lower toxicity alternative for high-risk patients requiring hematopoietic cell transplantation (HCT); however, it has not been widely used for ALL. We conducted a retrospective study of 24 high-risk adult ALL patients who received an RIC regimen of fludarabine (Flu)/melphalan (Mel) prior to allogeneic peripheral blood stem cell transplantation (PBSCT) between 6/14/02 and 6/15/07 at the City of Hope. Indications for the RIC regimen were: (1) aged 50 years or older (42%), (2) compromised organ function (54%), or (3) recipient of a previous HCT (37.5%). Patients had a median age of 47.5 years and the median follow-up was 28.5 months for living patients. Both overall survival (OS) and disease-free survival (DFS) at 2 years was 61.5%. Relapse incidence was 21.1% and nonrelapse mortality (NRM) was 21.5% at 2 years. Chronic graft-versus-host (cGVHD) developed in 86% of evaluable patients. In this series, no significant correlations were made between outcomes and patient age, presence of Philadelphia chromosome, relatedness of donor source, or prior HCT. These high survival rates for high-risk ALL patients following RIC HCT may offer a promising option for patients not eligible for a standard myeloablative transplant.
authors.affiliation: Department of Hematology/Hematopoietic Cell Transplantation City of Hope National Medical Center, Duarte, California 91010-3000, USA. astein@coh.org
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Stein
authors.forename: Joycelynne M
authors.initials: JM
authors.lastname: Palmer
authors.forename: Margaret R
authors.initials: MR
authors.lastname: O'Donnell
authors.forename: Neil M
authors.initials: NM
authors.lastname: Kogut
authors.forename: Ricardo T
authors.initials: RT
authors.lastname: Spielberger
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Slovak
authors.forename: Ni-Chun
authors.initials: NC
authors.lastname: Tsai
authors.forename: David
authors.initials: D
authors.lastname: Senitzer
authors.forename: David S
authors.initials: DS
authors.lastname: Snyder
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Thomas
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001549:Benzamides; D003131:Combined Modality Therapy; D000069439:Dasatinib; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation; D010879:Piperazines / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D011743:Pyrimidines / Q000008:administration & dosage; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D013844:Thiazoles / Q000008:administration & dosage; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D055815:Young Adult
chemical_list: D001549:Benzamides; D019653:Myeloablative Agonists; D010879:Piperazines; D011743:Pyrimidines; D013844:Thiazoles; D000068877:Imatinib Mesylate; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan; D000069439:Dasatinib