The role of allogeneic bone marrow transplantation in adult patients below the age of 55 years with acute lymphoblastic leukemia in first complete remission: a donor vs no donor comparison.

Abstract	The role of allogeneic bone marrow transplantation (alloBMT) in adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) remains controversial. At our institution, the policy is to offer alloBMT to ALL patients in CR1 up to the age of 55 years if a related donor is available. In addition, unrelated donor transplants are offered to patients with Philadelphia (Ph+) ALL. We report the results on 92 patients with ALL treated according to this policy from September 1992 to October 2001. Of the 87 patients achieving CR1, the comparison of patients with (n=48) or without donors (n=39) was done using an intention-to-treat approach. Of the 48 patients with donors (39 related and nine unrelated), 35 (73%) received alloBMT in CR1. No significant difference in 3-year event-free survival (EFS) (40 vs 39%, P=0.74) or overall survival (OS) (46 vs 58%, P=0.41) was seen in 'donor' vs 'no-donor' groups. For Ph+ patients, 3-year EFS and OS in 'donor' group were 46 and 57%, respectively, none of the patients in 'no-donor' group survived beyond 3 years. With our treatment strategy, 3-year OS of Ph+ patients was equivalent to Ph-negative (Ph-) patients (51 vs 52%, P=0.77). In conclusion, our data show that the policy of performing alloBMT if a sibling donor is available has not resulted in better outcome in Ph- patients.
Authors	V Gupta, Q-L Yi, J Brandwein, M D Minden, A C Schuh, R A Wells, K Chun, S Kamel-Reid, R Tsang, A Daly, T Kiss, J H Lipton, H A Messner
Journal	Bone marrow transplantation (Bone Marrow Transplant) Vol. 33 Issue 4 Pg. 397-404 (Feb 2004) ISSN: 0268-3369 [Print] England
PMID	14688816 (Publication Type: Comparative Study, Journal Article)
Chemical References	Antineoplastic Agents
Topics	Adolescent Adult Antineoplastic Agents (therapeutic use) Bone Marrow Transplantation (mortality) Cytogenetic Analysis Female Humans Male Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma (genetics, mortality, therapy) Remission Induction Retrospective Studies Survival Analysis Transplantation, Homologous Treatment Outcome

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