Non-myeloablative stem cell transplantation in patients with relapsed acute lymphoblastic leukemia: results of a multicenter study

• Published in: Bone marrow transplantation (Basingstoke) Vol. 40; no. 6; pp. 535 - 539
• Main Authors: GUTIERREZ-AGUIRRE, C. H, GOMEZ-AIMAGUER, D, CANTU-RODRIGUEZ, O. G, GONZALEZ-LIANO, O, JAIME-PEREZ, J. C, HERENA-PEREZ, S, MANZANO, C. A, ESTRADA-GOMEZ, R, GONZALEZ-CARRILLO, M. L, RUIZ-ARGÜELLES, G. J
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.09.2007
• Subjects: Acute lymphoblastic leukemia; Acute lymphocytic leukemia; Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Busulfan; Care and treatment; CD34 antigen; Child; Child, Preschool; Cyclophosphamide; Cyclosporin A; Development and progression; Disease-Free Survival; Female; Fludarabine; Graft versus host reaction; Graft vs Leukemia Effect; Graft-versus-leukemia reaction; Granulocytes - cytology; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Infant; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocyte Count; Leukocytes (granulocytic); Lymphatic leukemia; Male; Medical sciences; Methotrexate; Middle Aged; Mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prospective Studies; Recurrence; Remission; Remission Induction; Stem cell transplantation; Stem cells; Survival; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - methods; Transplantation, Homologous; Mexico; Human; Relapse; Hematology; lymphoblastic leukemia; Stem cell; Multicenter study; non-myeloablative; Hematopoietic cell; Acute leukemia; Malignant hemopathy; Non myeloablative treatment; Lymphoid neoplasm; Lymphoproliferative syndrome; allogeneic; Graft; transplant; Acute lymphocytic leukemia
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705769

Using non-myeloablative conditioning, allogeneic hematopoietic stem cell transplantation (HSCT) was conducted in 43 ALL patients in a CR2. The median age of the patients was 19 years. Patients received oral busulfan 4 mg/kg/day for 2 days; i.v. cyclophosphamide 350 mg/m(2)/day for 3 days; and i.v. fludarabine 30 mg/m(2)/day for 3 days. Oral cyclosporin A 4 mg/kg was started and methotrexate 5 mg/m(2) was delivered on days 1, 3, 5 and 11. The median CD34+ cell dose received was 5.0 x 10(6)/kg. The medium time to achieve a granulocyte count above 0.5 x 10(9)/l was 14 days. Thirteen patients were alive 30-1050 days after the HSCT. The 3-year overall survival rate was 30%. Ten patients (23%) developed acute GVHD, whereas eight patients (18.6%) developed chronic GVHD. Thirty patients died between days 47 and 1050 after the HSCT, most of them (70%) because of an ALL relapse. One hundred-day mortality was 15%, whereas transplant-related mortality was 21%. These results are inferior to those obtained using the same allografting method in other leukemias, probably as a consequence of poor susceptibility to the graft-versus-leukemia effect of the ALL cells beyond first remission as compared with other hematological malignancies.