Marrow Transplantation for Acute Lymphoblastic Leukemia: Factors Affecting Relapse and Survival

• Published in: Blood 1989-08, Vol.74 (2), p.862-871
• Main Authors: Barrett, A.John, Horowitz, Mary M., Gale, Robert Peter, Biggs, James C., Camitta, Bruce M., Dicke, Karel A., Gluckman, Eliane, Good, Robert A., Herzig, Roger H., Lee, Martha B., Marmont, Alberto M., Masaoka, Tohru, Ramsay, Norma K.C., Rimm, Alfred A., Speck, Bruno, Zwaan, Ferry E., Bortin, Mortimer M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Biological and medical sciences; Bone Marrow Transplantation; Child; Child, Preschool; Female; Graft vs Host Disease - prevention & control; Hematologic and hematopoietic diseases; Humans; Infant; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Postoperative Complications - prevention & control; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery; Prognosis; Recurrence; Remission Induction; Risk Factors
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V74.2.862.862

Transplant outcome was analyzed in 690 recipients of bone marrow transplants (BMTs) for acute lymphoblastic leukemia (ALL) in first (n = 299) or second remission (n = 391). Actuarial 5-year leukemia-free survival was 42% ± 9% (95% confidence interval) and 26% ± 6%, respectively; relapse rates were 29% ± 9% and 52% ± 8%, respectively. Five-year leukemia-free survival was 56% ± 18% in children and 39% ± 10% in adults (P ≪ .02) transplanted in first remission. In first-remission adults, non-T-cell phenotype, male to female donor-recipient sex-match and grafts-host disease (GVHD) were associated with decreased leukemia-free survival; inclusion of corticosteroids in the regimen to prevent GVHD was associated wth increased leukemia-free survival. Variables associated with decreased leukemia-free survival after second-remission transplants were age ≫16 years and relapse occurring while on therapy. Variables associated with increased probability of relapse were similar for first- and secondremission transplants and included GVHD prophylaxis without methotrexate and absence of GVHD. In firstremission transplants, leukocyte count ≫50 x 109/L at diagnosis was also associated with increased relapse; in second remission, relapse while receiving chemotherapy was also associated with increased posttransplant relapse. These data emphasize the importance of both disease- and transplant-related variables in predicting outcome after BMT. They may be used to explain differences between studies, design future trials, and identify persons most likely to benefit from BMT. © 1989 by Grune & Stratton, Inc.