TY - JOUR
T1 - Allogeneic bone marrow transplantation for patients with high-risk acute lymphoblastic leukemia
AU - Wingard, John R.
AU - Piantadosi, Steven
AU - Santos, George W.
AU - Saral, Rein
AU - Vriesendorp, Huibert M.
AU - Yeager, Andrew M.
AU - Burns, William H.
AU - Ambinder, Richard F.
AU - Braine, Hayden G.
AU - Elfenbein, Gerald
AU - Jones, Richard J.
AU - Kaizer, Herbert
AU - Stratford May, W.
AU - Rowley, Scott D.
AU - Sensenbrenner, Lyle L.
AU - Stuart, Robert K.
AU - Tutschka, Peter J.
AU - Vogelsang, Georgia Boyce
AU - Wagner, John E.
AU - Beschorner, William E.
AU - Brookmeyer, Ronald
AU - Farmer, Evan R.
PY - 1990
Y1 - 1990
N2 - Seventy-four consecutive patients with high-risk acute lymphoblastic leukemia (ALL) were given cyclophosphamide (CY; 50 mg/kg on each of 4 days) plus total body irradiation (TBI; 300 rad on each of 4 days) followed by a human leukocyte antigen (HLA)-identical allogeneic bone marrow transplant (BMT). Eighteen patients in first complete remission (CR1), 36 in CR2, 16 in CR3, and four in CR4 were transplanted. Patients in CR1 were transplanted 1 to 8 months (median, 3 months) after attaining CR. All 18 patients in CR1 had one or more poor risk factors: age more than 18 (N = 17), initial leukocyte count - 20,000 (N = 11), Ph1 chromosome (N = 2), delay in attaining CR more than 6 weeks (N = 8), or extramedullary disease (N = 1). Of those transplanted in CR2, 72% had relapsed on therapy. The 5-year event-free survival (EFS) rates for patients transplanted in CR1, CR2, and CR3 are 42%, 43%, and 25%, respectively, at median follow-up times of 57, 54, and 72 months, respectively. Children aged less than 18 years transplanted in CR2 have a 5-year EFS rate of 54%. All CR4 patients died early after transplant. The actuarial probability of relapse is 20%, 26%, and 48% for those transplanted in CR1, CR2, and CR3, respectively. Although there was substantial transplant-associated mortality, it decreased over the decade of the study (P = .01). This study indicates that BMT offers an attractive alternative to postremission chemotherapy in patients in CR1 with poor prognostic factors and in patients in second remission.
AB - Seventy-four consecutive patients with high-risk acute lymphoblastic leukemia (ALL) were given cyclophosphamide (CY; 50 mg/kg on each of 4 days) plus total body irradiation (TBI; 300 rad on each of 4 days) followed by a human leukocyte antigen (HLA)-identical allogeneic bone marrow transplant (BMT). Eighteen patients in first complete remission (CR1), 36 in CR2, 16 in CR3, and four in CR4 were transplanted. Patients in CR1 were transplanted 1 to 8 months (median, 3 months) after attaining CR. All 18 patients in CR1 had one or more poor risk factors: age more than 18 (N = 17), initial leukocyte count - 20,000 (N = 11), Ph1 chromosome (N = 2), delay in attaining CR more than 6 weeks (N = 8), or extramedullary disease (N = 1). Of those transplanted in CR2, 72% had relapsed on therapy. The 5-year event-free survival (EFS) rates for patients transplanted in CR1, CR2, and CR3 are 42%, 43%, and 25%, respectively, at median follow-up times of 57, 54, and 72 months, respectively. Children aged less than 18 years transplanted in CR2 have a 5-year EFS rate of 54%. All CR4 patients died early after transplant. The actuarial probability of relapse is 20%, 26%, and 48% for those transplanted in CR1, CR2, and CR3, respectively. Although there was substantial transplant-associated mortality, it decreased over the decade of the study (P = .01). This study indicates that BMT offers an attractive alternative to postremission chemotherapy in patients in CR1 with poor prognostic factors and in patients in second remission.
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M3 - Article
C2 - 2332770
AN - SCOPUS:0025236707
SN - 0732-183X
VL - 8
SP - 820
EP - 830
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 5
ER -