Unrelated Transplantation for Poor-Prognosis Adult Acute Lymphoblastic Leukemia: Long-Term Outcome Analysis and Study of the Impact of Hematopoietic Graft Source
Por:
Ferra, C, Sanz, J, de la Camara, R, Sanz, G, Bermudez, A, Valcarcel, D, Rovira, M, Serrano, D, Caballero, D, Espigado, I, Morgades, M, Heras, I, Solano, C, Duarte, R, Barrenetxea, C, Garcia-Noblejas, A, Diez-Martin, JL, Iriondo, A, Carreras, E, Sierra, J, Sanz, MA, Ribera, JM
Publicada:
1 jul 2010
Resumen:
Adults with high-risk acute lymphoblastic leukemia (HR-ALL) have a poor outcome with standard chemotherapy and usually undergo unrelated stem cell transplantation (SCT) if a matched sibling donor is not available. We analyzed the outcome of adult patients with unrelated SCT for HR-ALL and studied the possible effect of the hematopoietic stem cell source of the transplant. A total of 149 adult patients (median age, 29 years, range, 15-59 years) with HR-ALL underwent unrelated SCT in 13 Spanish institutions between 2000 and 2007. Patients in first complete remission (CR1) at transplantation had at least one adverse prognostic factor (advanced age, adverse cytogenetics, hyperleukocytosis, or slow response to induction therapy). ALL was in CRI in 81 patients (54%), in second CR (CR2) in 37 patients (25%), in third CR (CR3) in II patients (7%), and with overt disease in 20 patients (13%). The hematopoietic source was unrelated cord blood (UCB) in 62 patients and an unrelated donor (UD) in 87 patients. The patients undergoing UCB-SCT and UD-SCT were comparable in terms of the main clinical and biological features of ALL, except for a higher frequency of patients with more overt disease in the UCB-SCT group. There was no statistically significant difference in overall survival (OS) or disease-free survival (DFS) at 5 years between the 2 groups. Treatment-related mortality (TRM) was significantly lower in the UCB-SCT group (P = .021). The probability of relapse at 1 year was 17% (95% confidence interval [CI], 7%-27%) for the UD-SCT group and 27% (95% CI, 14%-40%) for the UCB-SCT group (P = .088), respectively. Only disease status at transplantation (CR1, 41% [95% CI, 18%-64%] vs CR2, 51% [95% CI, 17%-85%] vs advanced disease, 66% [95% CI, 46%-86%]; P = .001) and the absence of chronic graft-versus-host disease (74% [95% CI, 46%-100%] vs 33% [95% CI, 17%-49%]; P = .034) were significant factors for relapse. All unrelated transplantation modalities were associated with high treatment-related mortality for adult HR-ALL patients without a sibling donor. UCB-SCT and UD-SCT were found to be equivalent options. Disease status at transplantation and chronic GVHD were the main factors influencing relapse in both transplantation modalities. Biol Blood Marrow Transplant 16: 957-966 (2010) (C) 2010 American Society for Blood and Marrow Transplantation
Filiaciones:
Ferra, C:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Sanz, J:
Hosp La Fe, E-46009 Valencia, Spain
de la Camara, R:
Hosp Princesa, Madrid, Spain
Sanz, G:
Hosp La Fe, E-46009 Valencia, Spain
Bermudez, A:
Hosp Marques de Valdecilla, Santander, Spain
Valcarcel, D:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Rovira, M:
Hosp Clin Barcelona, Barcelona, Spain
Serrano, D:
Hosp Gen Gregorio Maranon, Madrid, Spain
Caballero, D:
Hosp Univ Salamanca, Salamanca, Spain
Espigado, I:
Hosp Virgen del Rocio, Seville, Spain
Morgades, M:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Heras, I:
Hosp Morales Meseguer, Murcia, Spain
Solano, C:
Hosp Clin Univ, Valencia, Spain
Duarte, R:
Hosp Duran & Reynals, Lhospitalet De Llobregat, Spain
Barrenetxea, C:
Hosp Gen Valle Hebron, Barcelona, Spain
Garcia-Noblejas, A:
Hosp Princesa, Madrid, Spain
Diez-Martin, JL:
Hosp Gen Gregorio Maranon, Madrid, Spain
Iriondo, A:
Hosp Marques de Valdecilla, Santander, Spain
Carreras, E:
Hosp Clin Barcelona, Barcelona, Spain
Sierra, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Sanz, MA:
Hosp La Fe, E-46009 Valencia, Spain
Ribera, JM:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Hybrid Gold
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