Allogeneic SCT in refractory or relapsed adult ALL is effective without prior reinduction chemotherapy

• Published in: Bone marrow transplantation (Basingstoke) Vol. 42; no. 12; pp. 791 - 798
• Main Authors: Terwey, T H, Massenkeil, G, Tamm, I, Hemmati, P G, Neuburger, S, Martus, P, Dörken, B, Hoelzer, D, Arnold, R
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-12-2008; Nature Publishing Group
• Subjects: Acute lymphocytic leukemia; Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Chemotherapy; Dosage and administration; Drug Resistance, Neoplasm; Drug therapy; Drug Therapy - utilization; Female; Fludarabine; Graft versus host reaction; Health aspects; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Internal Medicine; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - therapy; original-article; Patient outcomes; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prednisone; Public Health; Remission Induction; Retrospective Studies; Risk factors; Stem cell transplantation; Stem Cells; Survival; Survival Analysis; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - methods; Tumors; Young Adult; Germany; reinduction therapy; GVHD; SCT; relapse; acute leukemia; Human; Antineoplastic agent; Immunopathology; Graft versus host disease; Relapse; Treatment resistance; Hematology; Stem cell; Treatment efficiency; Hematopoietic cell; Homograft; Malignant hemopathy; Chemotherapy; Treatment; Lymphoproliferative syndrome; Graft; Adult; Acute lymphocytic leukemia; Reinduction treatment; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.258

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.