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Nonmyeloablative conditioning with allogeneic hematopoietic cell transplantation for the treatment of high risk acute lymphoblastic leukemia.

著者 Ram R , Storb R , Sandmaier BM , Maloney DG , Woolfrey AE , Flowers ME , Maris MB , Laport GG , Chauncey TR , Lange T , Langston AA , Storer BE , Georges GE
Haematologica.2011 Apr 20 ; ():.
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Background. Allogeneic hematopoietic cell transplantation is a potentially curative treatment for patients with acute lymphoblastic leukemia. However, the majority of older adults with acute lymphoblastic leukemia are not candidates for myeloablative conditioning regimens. A nonmyeloablative preparative regimen is a reasonable treatment option for this group. We sought to determine the outcome of nonmyeloablative conditioning and allogeneic transplantation in patients with high-risk acute lymphoblastic leukemia. Design and Methods. Fifty-one patients, median age 56 years, underwent allogeneic hematopoietic cell transplantation from sibling or unrelated donors after fludarabine and 2 Gray total body irradiation. Twenty-five patients had Philadelphia chromosome-positive acute lymphoblastic leukemia. Eighteen of these patients received post-grafting imatinib. Results. With median follow-up of 43 months, the 3-year overall survival was 34%. The 3-year relapse/progression and non-relapse mortality rates were 40% and 28%, respectively. The cumulative incidences of grades II and III-IV acute graft-versus-host disease were 53% and 6%, respectively. The cumulative incidence of chronic graft-versus-host disease was 44%. Hematopoietic cell transplantation in first complete remission and post-grafting imatinib were associated with improved survival, p=0.005 and 0.03, respectively. Three-year overall survival for patients with Philadelphia-negative acute lymphoblastic leukemia in first remission and beyond first remission were 52% and 8%, respectively. For patients with Philadelphia chromosome-positive acute lymphoblastic leukemia in first remission who received post-grafting imatinib, the 3-year overall survival was 62%; for the subgroup without evidence of minimal residual disease at transplantation, the overall survival was 73%. Conclusions. For patients with high-risk acute lymphoblastic leukemia in first complete remission, nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation, with post-grafting imatinib for Philadelphia chromosome-positive disease, can result in favorable long-term survival.
PMID: 21508120 [PubMed - as supplied by publisher]
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