title: Sequential chemotherapy and myeloablative allogeneic hematopoietic stem cell transplantation for refractory acute lymphoblastic leukemia.
abstract: The prognosis of patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) for refractory acute lymphoblastic leukemia (ALL) is very poor. To improve survival rates, we attempted to intensify the conditioning regimen with daunorubicin, vincristine, prednisolone, medium-dose etoposide, cyclophosphamide, and total body irradiation (DNR/VCR/PSL plus medium-dose VP/CY/TBI). Four patients in relapse or induction failure of B-precursor ALL without other complications underwent allogeneic HSCT. Initially, chemotherapy comprising DNR 60 mg/m(2) for 3 days, VCR 1.4 mg/m(2) for 1 day, and PSL 60 mg/m(2) for 3 days was administered, which was followed by medium-dose VP/CY/TBI; some modifications were made for individual patients. All patients achieved engraftment and complete remission after HSCT. Regimen-related toxicities were tolerable and no patient died within 100 days. Two patients were alive without disease on days 563 and 1,055. The third patient relapsed on day 951, while the fourth died on day 179 without disease. Our results indicate that intensified myeloablative HSCT should be considered for patients with refractory ALL.
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan. arita-tym@umin.ac.jp.|Third Department of Internal Medicine, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan. arita-tym@umin.ac.jp.
authors: Kotaro
authors: K
authors: Arita
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Takeshi
authors: T
authors: Kondo
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Junichi
authors: J
authors: Sugita
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Akio
authors: A
authors: Shigematsu
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Souichi
authors: S
authors: Shiratori
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Kentaro
authors: K
authors: Wakasa
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Atsushi
authors: A
authors: Yasumoto
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Makoto
authors: M
authors: Ibata
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Yusuke
authors: Y
authors: Shono
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Misato
authors: M
authors: Kikuchi
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Hideki
authors: H
authors: Goto
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Yukari
authors: Y
authors: Takeda
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Mutsumi
authors: M
authors: Takahata
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Naoko
authors: N
authors: Kato
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Mitsufumi
authors: M
authors: Nishio
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Shuichi
authors: S
authors: Ota
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Junji
authors: J
authors: Tanaka
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors: Masahiro
authors: M
authors: Imamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000628:therapy*; D012074:Remission Induction; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation; D055815:Young Adult