Allogeneic bone marrow transplantation for acute lymphoblastic leukemia during first complete remission

Area of Science:

• Hematology
• Oncology
• Transplantation Immunology

Background:

• Patients with acute lymphoblastic leukemia (ALL) and poor prognostic features face limited disease-free survival despite remission induction.
• Poor risk factors include advanced age, high white blood cell count, specific chromosomal translocations, and prolonged induction chemotherapy.
• Effective treatment strategies are crucial for improving outcomes in high-risk ALL populations.

Purpose of the Study:

• To evaluate the efficacy of high-dose radiochemotherapy and allogeneic bone marrow transplantation (BMT) in patients with ALL in first complete remission.
• To assess disease-free survival rates in patients with poor-risk ALL undergoing BMT.
• To identify failure patterns and causes of mortality post-BMT in this cohort.

Main Methods:

• Conducted a study involving 39 patients (1 infant, 38 adults) with ALL in first complete remission, preparing them for BMT from histocompatible sibling donors.
• Utilized high-dose radiochemotherapy as a conditioning regimen prior to transplantation.
• Analyzed prognostic factors, survival rates, and causes of treatment failure, including relapse, infection, and graft-versus-host disease.

Main Results:

• Twenty-six of 39 patients are alive and in complete remission at 4-72 months post-BMT (median 18 months).
• Actuarial survival in complete remission is 63% for the entire group and 60% excluding patients without poor-risk features.
• Leukemic relapse occurred in 16% of patients; other causes of failure included sepsis, graft-versus-host disease, interstitial pneumonia, and leukoencephalopathy.

Conclusions:

• High-dose radiochemotherapy followed by BMT from a histocompatible sibling donor can achieve high disease-free survival in younger adults with poor-risk ALL.
• The findings support BMT as a viable therapeutic option for selected high-risk ALL patients in first remission.
• Further prospective trials are warranted to compare BMT with conventional chemotherapy for poor-risk ALL.