Treatment of adult acute lymphoblastic leukemia with allogeneic bone marrow transplantation. Multivariate analysis of factors affecting acute graft-versus-host disease, relapse, and relapse-free survival.

Abstract

Between February 1972 and December 1987, 192 adults (greater than or equal to 18 years old) with acute lymphoblastic leukemia were transplanted using genotypically HLA-identical marrow donors. Median patient age was 23 years. Eighty-nine patients were in marrow remission and 103 were in relapse. Conditioning regimens included chemotherapy alone (three patients) or in combination with 9.2-17.5 Gy total body irradiation (189 patients). Graft-versus-host disease (GVHD) prophylaxis consisted of methotrexate and/or cyclosporine. Seventy-nine patients developed grades II-IV acute GVHD and 28 of 122 patients who survived at least 100 days developed chronic GVHD. Relapse-free survival at 5 years was 21% for patients transplanted in first remission, 15% for those in greater than or equal to 2nd remission, and 12% for those transplanted in relapse. Patient and donor characteristics were evaluated in multivariate analyses for their effect on development of acute GVHD, survival, relapse, and relapse-free survival. An increased risk of developing acute GVHD was associated with increasing donor age. Variables significantly associated with both increased survival and relapse-free survival included transplantation in first remission, younger patient age, and not developing interstitial pneumonia. A decreased probability of relapse was associated with transplantation in first remission, male patient sex, and grades II-IV acute GVHD.

• Authors: K Doney, L D Fisher, F R Appelbaum, C D Buckner, R Storb, J Singer, A Fefer, C Anasetti, P Beatty, W Bensinger
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 7 Issue 6 Pg. 453-9 (Jun 1991) ISSN: 0268-3369 [Print] England
• PMID: 1873592 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Cyclosporins
• HLA Antigens
• Methotrexate

Topics

• Acute Disease
• Adolescent
• Adult
• Bone Marrow Transplantation (adverse effects, immunology, mortality)
• Cyclosporins (therapeutic use)
• Female
• Graft vs Host Disease (epidemiology, prevention & control)
• HLA Antigens (immunology)
• Histocompatibility (immunology)
• Humans
• Incidence
• Male
• Methotrexate (therapeutic use)
• Middle Aged
• Multivariate Analysis
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (mortality, surgery)
• Transplantation, Homologous