title: Allogeneic Hematopoietic Stem Cell Transplantation for Adult Acute Lymphoblastic Leukemia: Results from a Single Center, 1993-2011.
abstract: Background:For adult ALL patients, the indications and appropriate timing of allogeneic hematopoietic stem cell transplantation (AHSCT) continue to be debated. The primary aim of this single-institution study was to compare the results of our adult ALL patients that had been allografted with those reported in the current literature.Subjects and Methods:This study included 53 consecutive adults with acute lymphoblastic leukemia (ALL) who underwent allogeneic hematopoietic stem cell transplantation (AHSCT) with myeloablative (92%) and reduced-intensity (8%) conditioning between 1993 and 2011.Results:Mean patient age was 27 years (SD:8.62) and donor age was 33.7 years (SD:9.47). Fourteen patients were in first remission; 21 in ≥2nd remission, 15 in relapse and 3 had primary refractory leukemia. Thirty-four, 15 and 4 patients received busulfan plus cyclophosphamide, cyclophosphamide/total body irradiation and fludarabine-based regimens, respectively. For graft-versus-host disease (GVHD) prophylaxis, cyclosporine plus methotrexate were used. Forty-six donors were related and 7 were unrelated. Thirty patients received granulocyte-colony stimulating factor (G-CSF) mobilized peripheral blood and 23 received bone marrow as stem cell source. Twenty-six patients relapsed at a mean duration of 11.3 months (SD:19.1). Forty-four patients succumbed to their disease after a mean follow-up of 13.6 months (SD:19.5). The cause of mortality was relapse (n=24; 54.5%) and transplant-related etiologies (n=20; 45.5%). The estimated five year probabilities of overall survival (OS) and progression-free survival (PFS) were 37% and 12%, respectively.Conclusion:By multivariate analyses, transplantation in first remission was the most important predictor of transplant success.
authors.affiliation: Department of Internal Medicine, Division of Hematology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Ipek
authors.initials: I
authors.lastname: Yonal-Hindilerden
authors.affiliation: Department of Internal Medicine, Division of Hematology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Kalayoglu-Besisik
authors.affiliation: Department of Internal Medicine, Division of Hematology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Nuray
authors.initials: N
authors.lastname: Gurses-Koc
authors.affiliation: Hematology Clinic, Istanbul Bakırkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Fehmi
authors.initials: F
authors.lastname: Hindilerden
authors.affiliation: Department of Internal Medicine, Division of Hematology, Istanbul Medipol University, Istanbul, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Sargin
keywords: Acute lymphoblastic leukemia; Allogeneic hematopoietic stem cell transplantation; Overall survival; Progression-free survival