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 Blood, 26 March 2009, Vol. 113, No. 13, pp. 2902-2905.
Prepublished online as a Blood First Edition Paper on January 28, 2009; DOI 10.1182/blood-2008-10-184093.

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CLINICAL TRIALS AND OBSERVATIONS

Brief report

Prolonged survival in adults with acute lymphoblastic leukemia after reduced-intensity conditioning with cord blood or sibling donor transplantation

Veronika Bachanova1, Michael R. Verneris1, Todd DeFor1, Claudio G. Brunstein1, and Daniel J. Weisdorf1

1 Blood and Marrow Transplant Program, University of Minnesota, Minneapolis

Twenty-two adult acute lymphoblastic leukemia (ALL) patients (21 of 22 in complete remission [CR]) received reduced-intensity conditioning followed by allogeneic transplantation. All patients were high risk. After a uniform preparative regimen (fludarabine 40 mg/m2 x 5, cyclophosphamide 50 mg/kg, 200 cGy total body irradiation), patients received either matched related (n = 4) or umbilical cord (n = 18) donor grafts. All patients reached neutrophil engraftment and 100% donor chimerism (median, days 10 and 23, respectively). Overall survival, treatment-related mortality (TRM) and relapse were 50% (95% confidence interval [CI], 27%-73%), 27% (95% CI, 9%-45%), and 36% (95% CI, 14%-58%) at 3 years, respectively. There were no relapses beyond 2 years. The cumulative incidence of acute and chronic graft-versus-host disease was 55% and 45%. Hematopoietic cell transplantation in CR1 (n = 14) led to significantly less TRM (8%, P < .04) and improved overall survival (81%, P < .01). For adults with ALL in CR, reduced intensity conditioning allografting results in modest TRM, limited risk of relapse, and promising leukemia-free survival. Clinical trial numbers are NCT00365287 [ClinicalTrials.gov] , NCT00305682 [ClinicalTrials.gov] , and NCT00303719 [ClinicalTrials.gov] .


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