Allogeneic marrow transplantation for acute leukemia in relapse

Area of Science:

• Hematology
• Oncology
• Stem Cell Transplantation

Background:

• Acute leukemias, including acute lymphoblastic leukemia and acute non-lymphoblastic leukemia, have poor prognoses when in relapse.
• Allogeneic marrow transplantation is a potential curative option for relapsed acute leukemias.

Purpose of the Study:

• To evaluate the efficacy of adding different chemotherapeutic regimens to a standard conditioning regimen for allogeneic marrow transplantation in patients with relapsed acute leukemias.
• To assess the impact of these combined regimens on relapse frequency and patient survival.

Main Methods:

• A retrospective review of 138 patients with relapsed acute lymphoblastic leukemia (75 patients) and acute non-lymphoblastic leukemia (63 patients) undergoing allogeneic marrow transplantation.
• Patients received a basic conditioning regimen of cyclophosphamide (Cy) and total body irradiation (TBI), with additional chemotherapy agents including dimethylbusulphan (DMB), 1,3-bis(2-chlorethyl)-1-nitrosourea (BCNU), or daunorubicin.

Main Results:

• Out of 138 patients, 17 (12.3%) survived between 3 and 9.5 years post-transplantation.
• The addition of DMB, BCNU, or daunorubicin to the cyclophosphamide and TBI regimen did not significantly decrease the frequency of leukemia relapse.
• No significant improvement in long-term survival was observed with the addition of these chemotherapeutic agents.

Conclusions:

• The addition of various chemotherapeutic agents to a conditioning regimen of cyclophosphamide and total body irradiation does not improve relapse rates or survival in patients with relapsed acute leukemias undergoing allogeneic marrow transplantation.
• Further research may be needed to identify more effective strategies for improving outcomes in this patient population.