Long-term follow-up of intensive ara-C-based chemotherapy followed by bone marrow transplantation for adult acute lymphoblastic leukemia: impact of induction Ara-C dose and post-remission therapy

• Published in: Leukemia research Vol. 26; no. 5; pp. 461 - 471
• Main Authors: Sotomayor, E.M., Piantadosi, S., Miller, C.B., Karp, J.E., Jones, R.J., Rowley, S.D., Kaufmann, S.H., Braine, H., Burke, P.J., Gore, S.D.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.2002; Elsevier Science
• Subjects: 4-Hydroperoxycyclophosphamide; Acute lymphoblastic leukemia (ALL); Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antimetabolites, Antineoplastic - therapeutic use; Autologous; Biological and medical sciences; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cytarabine - therapeutic use; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous; Bone marrow transplantation; Autologous; Acute lymphoblastic leukemia (ALL); 4-Hydroperoxycyclophosphamide; Human; Relapse; Prognosis; Antibody; Acute; Stem cell; Hematopoietic cell; Homograft; Malignant hemopathy; Induction treatment; Autograft; Chemotherapy; Cytarabine; Treatment; Lymphoproliferative syndrome; Maintenance treatment; Bone marrow; Graft; Myelosuppression; Acute lymphocytic leukemia; Pyrimidine nucleoside
• ISSN: 0145-2126; 1873-5835
• DOI: 10.1016/S0145-2126(01)00175-8

We report single institution outcome of brief, intensive ara-C-based chemotherapy using bone marrow transplantation as primary intensification for untreated adult patients with acute lymphoblastic leukemia (ALL). Overall disease-free and overall survival were inferior to those reported with prolonged chemotherapy modeled on pediatric protocols. Survival and disease-free survival were superior for patients receiving allogeneic BMT compared with chemopurged autologous transplant or maintenance chemotherapy (patients ineligible for or declining BMT). In multivariate analysis, non-L2-FAB, higher ara-C dose, absence of CNS disease, non-Ph1+ karyotype, allogeneic BMT, T cell phenotype, and younger age were associated with improved disease-free survival. Autologous BMT was not superior to chemotherapy, and appears unlikely to provide adequate curative treatment for most adult ALL patients if not followed by maintenance.