Journal
LEUKEMIA
Volume 24, Issue 12, Pages 2110-2119Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/leu.2010.217
Keywords
Philadelphia-negative acute lymphoblastic leukemia; adult; stem cell transplantation; allogeneic; autologous
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Funding
- Industry-Academic Cooperation Research Foundation
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We analyzed long-term outcomes of myeloablative stem cell transplantation (SCT) in 292 adults with Philadelphia (Ph)negative acute lymphoblastic leukemia (ALL). Donors were related (RD; n = 132), unrelated (URD; n 68; 30 well-matched (WM), 19 partially matched (PM), 19 mismatched (MM)) and autologous (AUTO; n 92). After a median follow-up of 85 months, the risk of relapse was higher for AUTO-SCT than for RD-SCT (P<0.001). MM-URD-SCT yielded higher risk of non-relapse mortality than RD-SCT (P = 0.010). As a result, disease-free survival (DFS) at 5 years was inferior using AUTO (46.1%; P _ 0.010) or MM-URD (26.3%; P _ 0.036), whereas DFS from other donor sources was approximately equivalent (53.5% for RD, 63.3% for WM-URD and 57.0% for PM-URD). Other factors associated with poorer DFS included SCT beyond first complete remission (CR), older age and adverse cytogenetics. In a pairwise comparison of outcomes between RD-SCT and AUTO-SCT for patients in first CR, the inferiority of AUTO-SCT was observed, particularly in high-risk patients. Conversely, in standard-risk patients, AUTO-SCT yielded comparable outcomes to RD-SCT. SCT using RD, WM-URD or PM-URD may be considered the best donor sources for adult high-risk Ph-negative ALL. Leukemia (2010) 24, 2110-2119; doi:10.1038/leu.2010.217; published online 30 September 2010
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