Allogeneic SCT in refractory or relapsed adult ALL is effective without prior reinduction chemotherapy
| Autor: | Stefan Neuburger, Theis H. Terwey, Gero Massenkeil, Ingo Tamm, P.G. Hemmati, Peter Martus, Renate Arnold, Dieter Hoelzer, B Dörken |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Transplantation Conditioning Adolescent medicine.medical_treatment Hematopoietic stem cell transplantation Young Adult Drug Therapy Refractory Acute lymphocytic leukemia Internal medicine medicine Humans Survival analysis Retrospective Studies Transplantation Chemotherapy Acute leukemia business.industry Remission Induction Hematopoietic Stem Cell Transplantation Retrospective cohort study Hematology Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Survival Analysis Surgery surgical procedures operative Graft-versus-host disease Drug Resistance Neoplasm Female Neoplasm Recurrence Local business |
| Zdroj: | Bone Marrow Transplantation. 42:791-798 |
| ISSN: | 1476-5365 0268-3369 |
| Popis: | We present 60 patients with refractory (n=8) or relapsed (n=52) adult ALL who received allogeneic hematopoietic SCT (HSCT) with (n=41) or without (n=19) prior reinduction chemotherapy. In our center, omission of reinduction is recommended if a suitable donor is promptly available, tumor burden is moderate and disease features suggest a highly aggressive course. Overall survival (OS) of the whole cohort at 1, 2 and 5 years was 42, 33 and 28%, respectively. Leukemia-free survival at 1, 2 and 5 years was 37, 33 and 24%. Deaths were due to relapse (n=25), acute or chronic GVHD (n=7), infections (n=8) or toxicity (n=4). Interestingly, patients who did not receive reinduction before HSCT had better outcomes than patients who received reinduction with OS at 1, 2 and 5 years being 58 vs 34%, 47 vs 25% and 47 vs 18%, respectively (P=0.039). Importantly, even achievement of a second CR after reinduction was not associated with improved survival compared to patients directly proceeding to HSCT. We conclude that patients who undergo HSCT for refractory or relapsed ALL can achieve long-term survival. In selected patients, reinduction chemotherapy can be omitted if immediate HSCT is feasible. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|