Abstract | OBJECTIVES: METHODS: Based on a search of the English literature for MUD transplant in Philadelphia-negative ALL, this review first compares the treatment outcomes of myeloablative allo-HSCT with MUD and MSD, followed by a mini-review of studies of non-myeloablative, reduced intensity conditioning (RIC) allo-HSCT in ALL, and finally measures to improve outcome of MUD allo-HSCT. RESULTS: Publications are inevitably confounded by inclusion of Philadelphia-positive cases, patients beyond CR1, and mismatched unrelated donors in addition to heterogeneity in the length of follow-up. Despite these limitations, the overall data showed that MUD allo-HSCT resulted in comparable survivals with matched related donor (MRD) transplant. Moreover, Asian studies reported a lower transplant-related mortality (TRM) than Western studies. As graft failure is infrequent even in the MUD setting, acute graft versus host disease (aGVHD) remains a major cause of TRM. In addition, RIC allo-HSCT produced promising long-term disease-free survival (DFS) with a low TRM in adult ALL if transplanted in CR1. DISCUSSION: Potential ways to reduce TRM further include antifungal prophylaxis and optimal management of life-threatening non-infective interstitial pneumonitis. Moreover, harnessing graft-versus- leukemia effect with hypomethylating agents warrants clinical trial. CONCLUSION: Myeloablative MUD allo-HSCT resulted in comparable survivals with MRD transplant. RIC allo-HSCT produced promising long-term DFS with a low TRM in adult ALL.
|
Authors | Y Y Hwang, M Mohty, C S Chim |
Journal | Hematology (Amsterdam, Netherlands)
(Hematology)
Vol. 20
Issue 2
Pg. 61-71
(Mar 2015)
ISSN: 1607-8454 [Electronic] England |
PMID | 24993587
(Publication Type: Journal Article, Review)
|
Chemical References |
|
Topics |
- Graft vs Host Disease
(immunology, mortality, pathology)
- Hematopoietic Stem Cell Transplantation
- Histocompatibility Testing
- Humans
- Myeloablative Agonists
(therapeutic use)
- Philadelphia Chromosome
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
(immunology, mortality, pathology, therapy)
- Siblings
- Survival Analysis
- Transplantation Conditioning
(methods)
- Transplantation, Homologous
- Unrelated Donors
|