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

Item Type:Article
Title:Allogeneic SCT in refractory or relapsed adult ALL is effective without prior reinduction chemotherapy
Creators Name:Terwey, T.H. and Massenkeil, G. and Tamm, I. and Hemmati, P.G. and Neuburger, S. and Martus, P. and Doerken, B. and Hoelzer, D. and Arnold, R.
Abstract: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.
Keywords:Acute Leukemia, SCT, Relapse, Reinduction Therapy, GVHD
Source:Bone Marrow Transplantation
Publisher:Nature Publishing Group
Page Range:791-798
Date:December 2008
Official Publication:https://doi.org/10.1038/bmt.2008.258
PubMed:View item in PubMed

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