title: Favorable outcome of unrelated cord blood transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia.
abstract: Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+)ALL) is one of the highest-risk ALL groups. Whenever possible, patients with Ph(+)ALL should undergo allogeneic hematopoietic stem cell transplantation (HSCT) after induction of remission. Although unrelated cord blood transplantation (CBT) has become a common treatment in adult patients who lack a sibling donor, data on the efficacy of CBT for Ph(+)ALL are limited. We analyzed the clinical outcomes of 20 Ph(+)ALL patients who underwent CBT (n = 8) or unrelated bone marrow transplantation (BMT) (n = 12). The median age was 41 years (range, 17-55 years). All but one of the patients were treated with an imatinib-based regimen before HSCT, and 19 patients were in first complete remission (CR) and 1 patient was in second CR at the time of HSCT. Seventeen patients received a myeloablative conditioning regimen containing 12 Gy of total-body irradiation, and 3 received a reduced-intensity conditioning regimen. After a median of 26 months of follow-up, estimated 3-year overall and leukemia-free survival rates were 100% and 85%, respectively, after CBT, and 49% and 38%, respectively, after unrelated BMT. The CBT group had significantly better overall survival than the BMT group (P = .02). Although BCR-ABL transcript was detected in 4 of 8 CBT patients at transplantation, 7 patients remained in molecular CR. Our findings suggest that CBT may be a viable option as postinduction therapy for Ph(+)ALL in patients lacking a sibling donor.
authors.affiliation: Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan. yonishi@med.tohoku.ac.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Onishi
authors.forename: Osamu
authors.initials: O
authors.lastname: Sasaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichikawa
authors.forename: Kyoko
authors.initials: K
authors.lastname: Inokura
authors.forename: Yuna
authors.initials: Y
authors.lastname: Katsuoka
authors.forename: Rie
authors.initials: R
authors.lastname: Ohtsuka Ohba
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okitsu
authors.forename: Katsura
authors.initials: K
authors.lastname: Kohata
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ohguchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Fukuhara
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Minami Fujiwara
authors.initials: MF
authors.lastname: Yamada
authors.forename: Joji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ishizawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Kameoka
authors.forename: Hideo
authors.initials: H
authors.lastname: Harigae
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D003131:Combined Modality Therapy; D036101:Cord Blood Stem Cell Transplantation / Q000706:statistics & numerical data; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000097:blood; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012074:Remission Induction; D012189:Retrospective Studies; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods*; D016896:Treatment Outcome; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019653:Myeloablative Agonists; D016044:Fusion Proteins, bcr-abl