T cell-depleted stem cell transplantation for adults with high-risk acute lymphoblastic leukemia: Long-term survival for patients in first complete remission with a decreased risk of graft-versus-host disease Journal Article
| Authors: | Goldberg, J. D.; Linker, A.; Kuk, D.; Ratan, R.; Jurcic, J.; Barker, J. N.; Castro-Malaspina, H.; Giralt, S.; Hsu, K.; Jakubowski, A. A.; Jenq, R.; Koehne, G.; Papadopoulos, E. B.; van den Brink, M. R. M.; Young, J. W.; Boulad, F.; Kernan, N. A.; O'Reilly, R. J.; Prockop, S. E.; Yahalom, J.; Heller, G.; Perales, M. A. |
| Article Title: | T cell-depleted stem cell transplantation for adults with high-risk acute lymphoblastic leukemia: Long-term survival for patients in first complete remission with a decreased risk of graft-versus-host disease |
| Abstract: | Consolidation with allogeneic hematopoietic stem cell transplantation (allo-HSCT) provides a survival benefit to patients with acute lymphoblastic leukemia (ALL). We have previously reported comparable survival and relapse rates after T cell-depleted (TCD) allo-HSCT compared with unmodified transplantations for acute myelogenous leukemia, myelodysplastic syndrome, and non-Hodgkin lymphoma with significantly decreased graft-versus-host disease (GVHD). We performed a 56-patient retrospective study to evaluate TCD allo-HSCT for the treatment of ALL after myeloablative total body irradiation-based therapy. The 2-year and 5-year overall survival rates for patients with ALL after TCD allo-HSCT were 0.39 (95% confidence interval [CI], 0.26-0.52) and 0.32 (95% CI, 0.19-0.44), respectively, and the 2-year and 5-year disease-free survival rates were 0.38 (95% CI, 0.25-0.50) and 0.32 (95% CI, 0.20-0.44). There was a trend toward improved survival of patients who underwent TCD allo-HSCT in first complete remission compared with those who did so in other remission states. The cumulative incidence of grade II-IV acute GVHD at 1 year was 0.20 (95% CI, 0.10-0.31), and no patients developed grade IV acute GVHD. The cumulative incidence of chronic GVHD in 41 evaluable patients at 2 and 5 years was 0.15 (95% CI, 0.04-0.26), and that of extensive chronic GVHD at 2 and 5 years was 0.05 (95% CI, 0-11.6). We demonstrate OS and DFS rates that compare favorably to unmodified allo-HSCT with lower rates of GVHD. © 2013 American Society for Blood and Marrow Transplantation. |
| Keywords: | adolescent; adult; cancer survival; disease-free survival; middle aged; survival analysis; survival rate; retrospective studies; young adult; major clinical study; overall survival; fludarabine; cohort studies; recurrence; cyclophosphamide; stem cell transplantation; hematopoietic stem cell transplantation; medical record review; retrospective study; thiotepa; acute lymphoblastic leukemia; high risk patient; cancer regression; chronic graft versus host disease; myeloablative conditioning; irradiation; graft versus host reaction; remission induction; donor lymphocyte infusion; precursor cell lymphoblastic leukemia-lymphoma; methylprednisolone; t cell depletion; graft vs host disease; thymocyte antibody; allogeneic transplantation |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 19 |
| Issue: | 2 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2013-02-01 |
| Start Page: | 208 |
| End Page: | 213 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2012.09.003 |
| PROVIDER: | scopus |
| PUBMED: | 22982534 |
| PMCID: | PMC3963704 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 February 2013" - "CODEN: BBMTF" - "Source: Scopus" |
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