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Marrow transplantation for acute lymphoblastic leukemia: factors affecting relapse and survival. Blood 1989 Aug 01;74(2):862-71 PMID: 2665858

Pubmed ID

2665858

Abstract

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 less than .02) transplanted in first remission. In first-remission adults, non-T-cell phenotype, male to female donor-recipient sex-match and graft-v-host disease (GVHD) were associated with decreased leukemia-free survival; inclusion of corticosteroids in the regimen to prevent GVHD was associated with increased leukemia-free survival. Variables associated with decreased leukemia-free survival after second-remission transplants were age greater than or equal to 16 years and relapse occurring while on therapy. Variables associated with increased probability of relapse were similar for first- and second-remission transplants and included GVHD prophylaxis without methotrexate and absence of GVHD. In first-remission transplants, leukocyte count greater than or equal to 50 x 10(9)/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.

Author List

Barrett AJ, Horowitz MM, Gale RP, Biggs JC, Camitta BM, Dicke KA, Gluckman E, Good RA, Herzig RH, Lee MB

Authors

Bruce M. Camitta MD Clinical Professor in the Medicine department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-0024337547   193 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Age Factors
Bone Marrow Transplantation
Child
Child, Preschool
Female
Graft vs Host Disease
Humans
Infant
Male
Middle Aged
Postoperative Complications
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis
Recurrence
Remission Induction
Risk Factors
jenkins-FCD Prod-296 4db9d02597e0a2e889e230f853b641c12f1c3ee3